How to Avoid Long-Term-Care Insurance Claims Rejections

Recent turmoil in the long-term-care insurance industry may lead to more claims rejections. Some suggestions for avoiding such rejections are below:

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    • Read the policy’s fine print before entering a facility or hiring a caregiver. For example, when a policy requires an aid from a “home health care agency,” insurers may deny a claim if an aid from a “home care agency” is hired. Or the policy may define an “assisted living facility” as a place with ten or more beds.
    • Know the requirements before preparing claims. For example, many older policies require a three-day hospital stay before they cover nursing home expenses.
    • Enlist help from an agent or geriatric-care manager in preparing claims.
    • Make sure the healthcare professional documents the disability adequately. Many policies require a nurse or doctor to certify that the disability will last at least 90 days.
    • Know the elimination period and how it is calculated.
    • When insurance assessors come verify the disability, don’t undermine the claim to spare the elderly individual embarrassment. Senior citizens don’t like admitting their lack of independence, but this isn’t the time to try to comfort them.

See Anne Tergesen, The Latest Long-Term-Care Snafu, W.S.J., Jan. 22, 2011.

Special thanks to Jim Hillhouse (WealthCounsel) for bringing this to my attention.