We understand how to work with your Long Term Care insurance company. We can do assignment of benefits resulting in direct payment to us, or help arrange payment to you. In either case, we assist with necessary paperwork (document filing), so in most cases you don’t have to pay anything out of pocket. A HIPPA agreement must be signed and usually a three way conversation with the policy holder, insurance coordinator and our office representative is neeeded to get the process started.
Long term care policies vary widely in how benefits are initiated and paid. We will work with you and your insurance company to review the various aspects of your policy. Elimination periods, daily/weekly benefits and general conditions of eligibility need to be confirmed. Certain activities of daily living ( ADL’S ) are required, usually 2 or 3 of 5 basic ones.
Also a doctor’s order, specific care plan and assessment needs to be initiated, executed, filed and monitored. There needs to be a discussion with the insurance company’s Benefits Manager regarding requirements for final approval, when benefits start and how/when they are paid to get needed approvals.
What triggers benefits is a key question and who decides if you’ve triggered them. Be sure you know who makes the final decision for approval. The insured is responsible for continuing payments to the registry until insurance company approves claim per the terms and conditions of their contract. This final approval is between the policy holder and insurance company. Many of the policy provisions vary from different insurance companies.
Most policies have a waiting period (elimination period), before you can start receiving benefits after you are considered medically eligible. Waiting periods vary from none to 20, 30, 60, 90, or 100 days. During any waiting period, you’re responsible for paying for your care. Some insurance companies require an exam by their nurse or physician. This can expedite the claim and may even reduce or eliminate the waiting period.
If you have long-term care insurance, call Treasure Coast Home Health Care and we will assist you in understanding your policy benefits and how you may be able to improve your life today. Call us at 772.872.6983 for a no-obligation estimate of your benefits.