For those who have Long Term Care (LTC) policies the ability to finally begin using the benefits can be a welcome relief to expensive care costs and overwhelming care needs of a loved one. Yet for many seniors and their families LTC paperwork can be daunting and complicated, at times to the point of seniors foregoing their benefits entirely as they are not able to navigate the complex document requirements. Whether the need to provide proof of eligibility, submit adequate documentation about the level of care provided and or make arrangements for benefit payments, the insurance paperwork can be a nightmare.
LTC benefits are paid when beneficiaries meet the terms of coverage in their policy, most frequently qualifying if they now require personal care assistance in 2 or more activities of daily living (ADLs) like dressing, grooming, bathing, toileting and eating or when they require constant supervision of another person due to severe cognitive impairment like dementia or Alzheimer’s Disease.
Initiating the benefit wait or elimination period, gathering necessary documentation to begin coverage and submitting ongoing documentation for the remainder of the time care coverage is provided can be more than an individual can manage alone. Many LTC processes require a large number of documents to be processed, some originating with the beneficiary or the responsible person for that individual and the others required from the professional care providers. Determining when an individual is able to utilize their LTC policy begins with contacting the company holding the policy, contacting the representative who brokered the policy or working with member services to walk through the entire process.
Once it is determined that a person qualifies to begin either the elimination process or covered services it is essential that documents are gathered which fulfill the company requirements to assure there is no delay in obtaining coverage once all conditions are met. For those who do not have the capacity to wade through the overwhelming paperwork, whether related to time, health or cognitive functioning other professionals including Geriatric Care Managers are available to assist in navigating the system with or for the individual. Additionally, those providing care (Home Health Care agencies, Assisted Living Care facilities…) for the patient can assist by providing or submitting all of the information necessary to initiate the claim and assure ongoing benefit payment throughout the duration of a person’s qualifying care.