ifish100 wrote: ↑Mon Jan 27, 2020 12:37 pm Thank you d0gerz and HereToLearn. Clear answers to the pot of money question and the 90d waiting period.
I will engage the insurance agent and get into the nitty gritty, I know better what to look for. It seems like the big things are the 2 ADL assessment and how big the pot of money is that is guessed at being needed.
It sounds like the term (time) is kind of a red herring, that is confusing they even mention it. You are buying potential access to a pot of money for you and your spouse, saving some money by getting the married couple discount. The access is determined by the gatekeeper certifying you have 2 ADL shortfalls. I like what HereToLearn said, it may not be applicable to the most common normal aging cases, that would have been my guess too.
I hope the LTC insurance claims department is not as frustrating to deal with as the claims department on automotive policies. The nice friendly local sales agent, then when dealing with the claims department a very cold phone call dealing with people with bad attitudes, just worried about keeping as much of their money as possible.
It will be interesting to dig into the LTC insurance. I have a lot to learn.
Filing a long-term care insurance claim is hard, for 5 reasons:
1) it’s brand new for everyone. Even though over one million people have received benefits from their long-term care policies, most of us have never filed a long-term care insurance claim. Your doctor has lots of experience filing medical insurance claims, but little or no experience filing long-term care insurance claims. Who do you turn to for help?
2) Before approving a claim the insurance company needs to review the policyholder’s medical records. To prevent medical records from getting into the wrong hands, privacy laws have created roadblocks which are designed to protect you. These same roadblocks, however, can cause delays in getting your medical records from your doctor’s office to the insurance company’s claims personnel.
3) The policyholder is usually not the one submitting the claim. If a relative of the policyholder is submitting the claim the doctor’s office needs to know the relative has the legal authority to represent the policyholder. Until the doctor’s office is satisfied that you have legal authority to represent the policyholder, they can’t send any records to the insurance company. That’s why legal documents like a durable power of attorney should be in place well in advance.
4) Most communication with the insurance company has to be done via “snail mail” or over the phone. Sending health information via unsecure fax or email is a potential HIPAA violation subjecting the insurance company to huge fines. This can add to the frustration and delay the approval process even longer.
5) Lastly, insurance laws in most states require the insurance company to either approve or deny the long-term care insurance claim within 60 days from the date they received the claim form. If the medical records have not been received within that time, the claim has to be initially denied.
When my relative decided to file a claim on her long-term care policy in 2017 I did NOT handle her claim for her. Even though I’m a licensed insurance agent and I’ve specialized in long-term care insurance for 25 years, I didn’t handle her claim.
We contacted one of the larger national home care agencies and they handled it for us. This particular home care agency processes THOUSANDS of long-term care insurance claims every year. All we had to do was sign a couple of HIPAA forms and they took care of the rest. Her claim was approved in only 3 weeks.
They handled the claim for free. It makes sense.
The home care agencies get paid by the long-term care insurance companies.
They have a financial incentive to set up a system to speedily process long-term care insurance claims.