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Ways to help ensure that your long-term care claim isn’t denied

When it comes time for you, a parent or older loved one to make a claim on a long-term care insurance policy, you may believe that there will be no complications. An LTC policy is a wise choice to help cover the cost of assisted living, nursing home or at-home care when you reach the point where you need assistance with daily living.

However, there is no guarantee that the insurer will pay your claim. As with any kind of policy, the devil can be in the details. That’s why you should be aware of some things that may prevent your insurer from paying needed benefits before you file your claim.

First, it’s essential to carefully read your policy. This will help ensure that you submit the claim properly.

Include as much information as you have to back up your claim. Don’t limit yourself to the questions asked. It’s helpful to submit documentation from your physician stating that you need a particular type of treatment or care. Too much information is always better than too little if it helps substantiate your claim.

If you are remaining in your home, but need the services of a home health aide, find out what kind of documentation that aide will need to provide the insurer. Many insurers require this.

If you are submitting the claim on behalf of a parent or loved one, you will likely need that person to sign a document authorizing you to handle any policy disputes. If you are their power of attorney or health care proxy, let them know that.

If it’s a parent or elderly loved one who is submitting a claim, you should be present for any assessment done by the insurer. Often, older people don’t want to admit that they need assistance with daily activities even when they do. Such pride, unfortunately, can result in claim denials. You want to help ensure that the assessor sees that your loved one requires assistance.

If a claim is denied, ensure that any communication with the company is handled, or at least followed up, in writing. Ask the insurer to put any requests or reasons for denial in writing.

You may benefit from seeking legal guidance. Attorneys with experience dealing with denied insurance claims know how to deal with insurers to help clients get the benefits to which they’re entitled.

Source: Forbes, “How Long-Term Care Insurers Deny Benefits,” Richard Eisenberg, accessed June 02, 2015

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