Long-Term Care Claims Processing Story
At age 76, Thomas lived alone. A few years back, he was diagnosed with lung cancer. He underwent radiation and chemotherapy and after two months of treatment, he was able to resume his normal activities. On a recent visit, his daughter, Sara, noticed her dad seemed tired. He’d lost weight, his balance was unsteady, and he seemed to be having trouble eating and swallowing. Sara insisted he see his doctor. Additional testing revealed the cancer had spread. Thomas was given a life expectancy of six months and his doctor recommended home health care services and hospice care.
The Long-Term Care Claims Process
Sara called the insurance company to initiate a claim. A Benefit Claim Specialist explained the provisions of the policy and sent her the claim forms to complete. Once they received the completed forms, HIPAA authorization and Power of Attorney documentation, they requested an Attending Physician Statement (APS) along with a certificate of terminal illness and the most recent office notes. They verified the home health care and hospice agency were licensed and approved the claim.
The Benefit of Long-Term Care Insurance
Thomas’s long-term care policy provided benefits to help pay for the care he needed during his final months. He received daily visits from a home health aide who helped with bathing, dressing, feeding, and transferring from his bed to a chair. As his health declined, Thomas received round-the-clock hospice care until he passed away at his home with his family by his side. Thanks to his long-term care policy, Thomas received loving end-of-life care, which gave Sara peace of mind knowing her father’s needs were taken care of.
The policies in the portfolio provide coverage for:
Home Health Care — Pays up to 100% of the policy’s monthly benefit for:
• Personal care services to assist with the activities of daily living
• Homemaker services to help with housekeeping, grocery shopping and meal preparation
• Professional services of a nurse, home health aide or therapist
• Adult day care
Hospice Care — Pays maximum monthly benefit for hospice care services (private-pay, non-Medicare covered services) provided in any setting
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