A Guide to Long-Term Care Insurance | San Diego Home Caregivers

Maximizing the benefits of long-term care insurance begins with understanding your policy.

Long-term care insurance can provide extraordinary peace of mind, but utilizing those benefits can wind up to be a perplexing experience for seniors and their family members. To help lead families through the process, San Diego Home Caregivers provides this helpful overview.

Which services are covered?

Prior to filing a claim, it is important to carefully review the long-term care insurance policy in order to gain an understanding of the types of services the policy covers. If you do not have a copy of the policy, get in touch with the provider to ask for one.

Although all policies differ in what they cover, long-term care insurance usually covers non-medical services in the home with the condition that support is necessary for two or more activities of daily living, or the policyholder has been diagnosed with some type of cognitive condition, such as dementia. Examples of the type of care that long-term care policies might cover include:

Personal care, such as bathing and dressing
Transfers and ambulation
Using the bathroom and incontinence care
Meal preparation and feeding if needed
Housekeeping
And more

If you or a senior loved one would like assistance understanding the details of the policy, an insurance agent, elder care attorney or financial planner can help.

Are all of the costs of care covered?

While individual plans vary, every plan details the permitted monthly coverage, which is identified as the “present daily allowance,” and frequently has a specified lifetime maximum. Policies also usually identify a particular duration of time for which the benefits are accessible, such as five years, or the coverage may be effective for the policyholder’s lifetime.

It’s also important to check the long-term care plan’s elimination period. The elimination period is the time during which the cost of care is paid out-of-pocket until a predetermined amount of time has gone by. Although some plans identify a zero-day elimination, which means cost for care and coverage begin immediately, other policies might require up to 120 days of care first.

Choose your care provider carefully.

If you plan on filing a claim for long-term care insurance, it is important to work with a home care company with experience in billing long-term care insurance providers; otherwise, there is the possibility that the claim may not be reimbursed. San Diego Home Caregivers has experience with helping families obtain their long-term care insurance benefits and can provide the documentation needed to help clients file claims properly.

How can claims be filed?

In order to file a long-term care insurance claim, the following documents are usually required:

A claimant’s statement (or policyholder statement) describing the reasons for the claim
A statement from a doctor, verifying that care is warranted
A prescribed care plan and nursing evaluation
A provider statement, completed by the home care agency
An authorization form

Once completed and submitted, a phone interview is scheduled with the insurance company’s claims department. In the next step, the claim is either approved or denied.

If you are looking to receive home care services through a long-term care policy, call San Diego Home Caregivers today at (619) 487-9000. You can feel confident in knowing that we have years of experience in not only providing exceptional care in the comfort of home, but also in assisting families with long-term care insurance claims and getting the most out of their plan. To learn more about our premier options for senior care in San Diego and surrounding areas, please contact us today.