Long-Term Care Insurance Claims for Home Care

If your loved one has a long-term care insurance policy, it may pay for much of the cost of a caregiver at home. Many families have paid premiums for years but are not sure how to start a claim, especially in the middle of a health setback. Accountable Home Care, Inc. is a locally family-owned and operated, licensed nurse registry in Palm Beach Gardens, serving families since 2014. Our care navigators help families in Palm Beach and Martin County start their claims, from gathering records from the doctor to filling out claim forms, at no additional cost.

What Long-Term Care Insurance Usually Pays For

Most long-term care policies pay for help at home, not only in a nursing home or assisted living. Depending on your policy, benefits may cover:

• Hourly care from licensed caregivers, such as CNAs and home health aides
• Help with bathing, dressing, toileting, transfers and eating
• Supervision and companionship for someone with dementia
• Overnight care and 24-hour home care
• Respite care for family caregivers, often with its own limit

Every policy is different, and your policy’s terms always decide what is covered.

When Can You Start Using Your Policy?

Most tax-qualified long-term care policies start paying when a licensed health care practitioner certifies that your loved one:

• Needs help with at least two of the six activities of daily living (bathing, dressing, eating, toileting, transferring and continence) for at least 90 days, or
• Needs substantial supervision because of a severe cognitive impairment, such as Alzheimer’s disease or another dementia

Older policies may use different rules. Learn more in our questions about activities of daily living.

Terms to Look for in Your Policy

• Elimination period: the waiting period before benefits begin, often 0, 30, 60, 90 or 100 days. Some policies count calendar days; others count only days you receive paid care.
• Daily or monthly benefit: the most the policy will pay for care each day or month
• Lifetime maximum or benefit pool: the total the policy will pay over time
• Inflation protection: whether your benefit has grown since you bought the policy
• Home care coverage: how much of the benefit applies to care at home, and which caregivers qualify
• Waiver of premium: many policies stop premium payments once you are receiving benefits
• Care management: some policies include a care coordinator from the insurance company
• Durable medical equipment (DME): some policies help pay for items such as a shower chair or hospital bed. We can help you coordinate medical supplies and equipment.

How to File a Long-Term Care Insurance Claim, Step by Step

1. Find the policy. Locate the policy number and the insurance company’s claims phone number, usually on the policy or a recent premium notice.
2. Call the insurance company to open a claim. Write down the claim number, the date and the name of each person you speak with. We can join the call with you.
3. Complete the claim packet. It usually includes a claimant statement, an attending physician statement and a form allowing the insurer to request medical records.
4. Ask the doctor’s office for records. Notes showing that your loved one needs help with daily activities, or has memory problems, support the claim. Our care navigator can help you request them.
5. Complete the insurer’s assessment. Many insurance companies have a nurse or care manager assess your loved one at home or by phone.
6. Start care and track the elimination period. Keep a record of the dates care is provided.
7. Submit invoices and caregiver notes. Most policies reimburse you after you send invoices and care notes showing the help given. Some can pay the provider directly, so ask your insurance company.

Claim decisions can take several weeks. Many families start care right away and pay privately while the claim is reviewed.

Does Your Policy Cover a Nurse Registry?

Many long-term care policies pay for caregivers referred by a licensed nurse registry like ours. Some older policies require care from a licensed home health agency. Our care navigators can review your policy’s provider rules with you before care starts. Learn the difference between a nurse registry and a home care agency. Accountable Home Care, Inc. holds Florida Nurse Registry License #30211765.

Caregiver Notes That Support Your Claim

Insurance companies want to see that your loved one received help with daily activities. Caregivers keep care notes, such as standby help while bathing or help with dressing, so your claim paperwork reflects the care your loved one actually receives.

If a Claim Is Delayed or Denied

• Ask the insurance company to explain the reason in writing
• Ask what more they need, such as an updated physician statement or medical records
• Follow the policy’s appeal process and deadlines
• For help with an insurance company, Florida residents can call the Florida Department of Financial Services Consumer Helpline at 1-877-693-5236

Life Insurance and Hybrid Policies

Some life insurance policies include a long-term care or chronic illness rider, and hybrid life and long-term care policies are common. These may also pay for care at home. Check the policy or call the insurance company to ask how to use the benefit, and we can help you with the paperwork.

Long Term Care Insurance Policies AHC Accepts

Below is a short list of the insurances we accept and work with.  Should you not see the insurance you have purchased, please do not hesitate to contact our home care office at 561.320.0055.

• AF&L/American Fidelity & Liberty
• AIG
• American Heritage
• American Pioneer
• American Travelers
• Bankers Life
• Blue Cross Blue Shield-long term care
• Conseco
• Colonial American
• CNA Insurance Company
• GE Life Assurance & Annuity Company
• GenWorth
• GTL Insurance
• John Hancock
• Kanawha
• Lincoln Benefit
• Metlife
• Mutual of Omaha
• Old American
• Penn Treaty Insurance
• Senior Health Insurance Company of Pennsylvania/SHIPP
• Trans America
• Transport Life Insurance
• Union Labor
• Washington National

Common Questions About Long-Term Care Insurance and Home Care

Will long-term care insurance pay for 24-hour care? It can. Coverage depends on your policy’s daily or monthly maximum. Some families combine insurance benefits with private pay for longer schedules. See how much home care costs.

Does Medicare pay for long-term care at home? No. Original Medicare covers short home health visits that a doctor orders, but not ongoing non-medical care. Learn the difference between home health care and in-home care.

Can we start care before the claim is approved? Yes. Many families start care right away. Ask your insurance company whether care given before approval counts toward the elimination period or can be reimbursed.

Is there a fee for help with the claim? No. Our care navigators help clients with their long-term care insurance claims at no additional cost.

What if we also qualify for VA benefits? Veterans and surviving spouses may qualify for VA Aid and Attendance, which can help pay for care at home.

Get Help With Your Long-Term Care Insurance Claim

Call (561) 320-0055 or schedule a free in-home assessment. Have your policy handy, and a care navigator will help you understand your benefits and start your claim.

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