Introduction

In an earlier article on the topic of Long-Term Care Insurance (“LTCI”) claims, we said there were a number of important things to know about filing LTCI claims in San Diego County.  In this four-part series of articles, we’ll talk about filing the claim right away and making sure that it’s complete the first time you submit the claim.

The List:  The Top Six Things To Know and Do When Filing New Long Term Care Claims In San Diego County

Here are the six most important things to know and do when filing new LTCI claims inSan DiegoCounty:

1. Decide Who Is Going To Be In Charge Of Filing The Claim.
2. The Insurance Company’s Goal is NOT To Pay Claims
3. How Do Insurance Companies Delay Paying Claims?
4. How Do Insurance Companies Delay Paying Claims?
5. You Need To Have A Complete Copy Of The LTCI Policy.
6. Ask Your In-Home Care Agency To Complete the Provider Information Form in the LTCI claim forms package.

Decide Who Is Going To Be In Charge Of Filing The Claim

In situations where there are multiple family members who are helping another family member, typically an older parent or relative, it’s a good idea to decide on one family member to be the “project manager” in charge of filing the claim.  That project manager should be the one who then talks with the insurance company on behalf of the insured and rest of the family, and who actually carries out the initial claims process described here.

The Insurance Company’s Goal is NOT To Pay Claims

The insurance companies will only honor their policy terms.  Those terms normally do not require them to help you file claims and qualify for benefits.

Some insurance companies are worse in this regard than others, but all of them basically make you do the work of filing the claim and proving that you are eligible to receive benefits under the policy.  They’ll send you the forms you need (sometimes not all at once, leading to delays) but that’s about all they do.  If they want to send out a nurse to make an assessment, that’s just to make sure that your claim is legitimate, not to help you with any aspect of filing the claim.

What happens when you have to do the work and they don’t help you?  The main result is that it takes longer to complete the process and delays the start of their claims payments to you.  The insurance companies benefit from delaying the payment of claims because it gives them longer to keep the insured’s money and earn more investment income and interest with it.

Summary

So, remember to decide which one specific family member is going to be responsible for managing the claims filing process for the family, and make sure that when you do file the claim, you do everything you can to make certain that the claim information and forms that you send are complete and sufficient for the LTCI company to decide upon the policyholder’s eligibility without further delay.

In Part Two of this series we’ll look at how LTCI companies delay and even, in some cases, avoid paying LTCI claims by making the process so slow and lengthy that some people just give up, and how to prevent that from happening.

Call 1-800-777-4750 Today For Assistance With
Filing Your LTCI Claim and Your In-Home Care Needs!

A Servant’s Heart Care Solutions has assisted many clients and their families file their LTCI insurance claims since 2003.  It would be a privilege for us to have the opportunity to help your family as well!

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