Long-term care insurance (LTCI) is a privately owned insurance policy that pays for the cost of live-in custodial care. An individual will pay monthly premiums until there is a need for assistance with activities of daily living (ADLs). Typically an LTCI policy requires assistance with three or more ADLs for the beneficiary to qualify to receive payments for live-in elder care services.
Make life easier by reviewing the list below. Addressing these items early will reduce much stress and disappointment when submitting a claim with your long term care insurance company.
Keep medical records: Keep track of contact information from every medical appointment or facility visited. Frequently children try to collect this information from an elderly parent who has cognitively declined and is unable to provide the necessary documents. We have come across LTCI providers requesting the past two years of medical records.
Hiring a private aide: The first mistake when submitting for payments with an LTCI company is hiring a live-in aide privately. A private aide is a caregiver that is not working under the supervision of a properly licensed home care agency. Some LTCI policies pay for private home health aide services, but more and more are requiring policyholders to work with a licensed live-in elder care agency.
Licensed live-in agency: Ensure that the live-in senior care agency can provide proof of a state license. LTCI companies will ask for a copy before releasing payments of non-medical care services received.
Proof of insurance: Can the live-in home health care agency provide proof of insurance? Many times LTCI companies require proof of workers compensation, general and professional liability, and a bond to protect the client from any unforeseen financial hardships when receiving live-in elder care.
Pay agency directly: Who is paid? The agency or the caregiver? The issue with paying a caregiver directly is that the home health aide would not be covered under the agency's insurance policies, thereby exposing the homeowner to potential liability.
Certified Home Health Aides: What is the agency's training program? Some states have an official home health aide license and others do not. Some LTCI companies want proof of the live-in aide's certification from a state recognized training program. This request is not common, but we have had some companies demand proof of individual certifications in addition to the agency license before releasing payments.
Follow-Up: Checking in with your LTCI company at least once a month is crucial to verify that all required documents have been received to process payments for live-in care. LTCI companies require an invoice attached with caregiver notes that identify the type of care received on a daily basis. Many times insurance companies will also review the plan of care in place for the beneficiary.
It is a good idea to purchase an LTCI policy for yourself and your loved one. If you have any further questions, feel free to comment below or contact me by sending an email.