Long Term Care Insurance: Dot your “I”s and Cross your “T”s

Long term care insurance is typically purchased by an individual in anticipation of needing help with their caregiving needs should injury or disability develop.  Every year we have a few percentage points higher of clients that own a long term care policy and want to use it to either pay for all or help defray costs of care with our company.  As we have had a handful of clients who first hired companies that did not review their policies and therefore did not meet the criteria for those companies to help pay for their care, here are a few suggestions.

  1. The home care company representative should always ask to review your policy with you prior to the start of care.  Many companies have different requirements for the home care agency that they reimburse.  Some require registered nursing oversite by reviewing care notes.  Some require an R.N. visit on a regular basis.  You want to use a company that is familiar with long term care policies and knows the right questions to ask. As CareForce is a home health agency, most policies cover our care.  You can be certain that we will not start care unless we know what you need.
  2. The home care company is willing, if need be, to call the insurance company prior to start of care to make certain that they are meeting all of the criteria.  Just this week a client in Renton was thankful that CareForce called their company as a recent company did not, and was unable to get reimbursement for this client.  At CareForce it is our policy to contact all insurance companies prior to start of care to insure we are meeting all of the criteria.
  3. Is there a credential required for your company?  RN? Nursing Assistant Certified?  Please make certain you know about this.
  4. Do you have a deductible to meet prior to reimbursement?  This is typically a number of days receiving home care services prior to getting reimbursed.  Many policies begin immediately, yet many require 30, 60 or even 90 days of services paid out of your pocket before their payments can begin.
  5. If your policy requires a deductible number of days, is their a clause that when on hospice care your deductible is waived?  Investigate this ahead of time.  Many better policies do have this waiver so you can begin reimbursed care right away.
  6. Know your daily reimbursement and limits of time for reimbursement.  Some policies pay nearly all of your costs, but many pay for 4-6 hours of care per day for a limited number of days.  Learn your benefit now or when you purchase so that you aren’t surprised at additional out-of-pocket costs.

Recently we had a client who was on Hospice who had a long term care insurance policy.  Between the care manager, Carolyn, RN, and our Payroll and Insurance Specialist, Veronica de Gier-Marlow, in less than 48 hours all of the questions were answered and the policy was activated.  This insurance company told Veronica that they had never had an agency be so thorough and timely to help a client.  I’ll take that as the answer to the question….Should you seek care with CareForce if you have Long Term Care Insurance?  We dot all the “I”s and cross all the “T”s for you to help you receive your reimbursement.