HOUSTON LONG-TERM CARE INSURANCE CLAIMS LAWYER

Top-Rated Long-Term Care Insurance Attorney

As you get older, you may need additional assistance for your day-to-day activities. In this case, you’ll likely require some form of long-term care if your daily activities, such as eating or walking, are a struggle to perform independently. However, as many know, long-term care is extremely expensive. So, to help cover the cost of long-term care, long-term care insurance is available. This covers various services. But, you may find, down the road, that some insurance providers unfairly deny your claim or increase premiums. Long-term care insurance policies can be complicated and costly. Providers oftentimes deny claims for obscure reasons. We help those struggling with long-term care insurance claims in the Houston area. While most long-term care insurance companies pay a daily amount to help cover the cost of long-term care services, you may still hit a road block. If you have trouble receiving long-term care benefits through your insurance provider, hire a long-term care insurance claims lawyer to make sure you receive fair coverage.

What Is Long-Term Care Insurance?

Long-term care insurance covers both personal and custodial care for those who have trouble performing activities of daily living, also known as ADLs. These long-term care policies reimburse policyholders with a predetermined amount of money per day.

A wide range of care options and benefits exist under long-term care insurance policies. This allows the recipient to select services that are the best fit for their personal situation, including which services they need and where they’ll receive them.

Long-Term Care Insurance Coverage

Long-term care insurance policies are comprehensive. They allow policyholders to use benefits in a variety of settings.

Long-term care insurance offers benefits to help cover costs in:

  • adult service centers
  • Alzheimer’s special care facilities
  • assisted-living facilities
  • Hospice care
  • nursing homes
  • Respite care
  • your home

If you are being cared for in your home, many long-term care policies will cover services that make care easier for the home setting. 

How to Receive Long-Term Care Benefits

Before you can receive your benefits from a long-term care insurance policy, you must first meet eligibility requirements. These are called benefit triggers. In addition, you must also allow time to pass in an elimination period. 

Benefit Triggers

Benefit triggers for long-term care policies allow the insurance company to ensure you’re eligible for benefits. This is determined by an assessment that is carried out by way of a social worker or nurse. As we mentioned earlier, this assessment is defined by activities of daily living. 

Although each long-term care policy is different, many policies will require that you need help with at least 2 of the 5 activities of daily living to be eligible for long-term care benefits.

Activities of Daily Living include:

  1. bathing
  2. bladder and bowel control
  3. dressing
  4. eating
  5. moving from one place to another

Elimination Period

The elimination period is a set amount of time that must pass after a benefit trigger, before you can start receiving benefits. This means that you must choose an elimination period, such as 30, 60, or 90 days when you purchase the long-term care insurance.

You must pay for any long-term services on your own before the elimination period ends. You’ll want to be sure that you understand the policy. This is because most policies require that you receive long-term care services during this entire period.

What To Do Before Filing A Long-Term Care Insurance Claim

If you want to ensure that your long-term care insurance claim isn’t denied or undervalued, you may take a few proactive steps before filing your claim. Although most insurance providers will pay out eligible claims in good faith, some may use shady tactics to deny or undervalue your claims.

Understand You Long-Term Care Insurance Policy

Many seniors, as well as their family members, spend months or even years trying to get insurers to cover the costs of services. This is the main reason why it is so important to understand your policy. You need to read the fine print and be aware of any traps that will deny your claim.

One popular trap is the elimination period. Some plans will only count the days that the policyholder received services. For example, if a nurse only visits twice a week, some policies will only count those 2 days in the 60-day elimination period. This would extend the wait time to several months.

In order to avoid any problems, you’ll want to file your claim as soon as you believe you may need benefits. The insurance provider will more than likely send a nurse or social worker to assess your situation, receiving benefits can take a significant amount of time. 

Confirm ADL Assistance With a Doctor's Report

Insurance providers will need to see documentation that the policyholders is having trouble performing at least 2 of the 5 ADLs. Your primary care physician or healthcare provider should confirm this, in writing. This can be printed, email, or another form sent to the insurance company. 

Make sure that your doctor writes about conditions that meet the eligibility requirement outlined in your specific insurance policy. For example, if you need help bathing, have your doctor write that you need assistance with that in his or her report. 

Confirm Caregiver Requirements

If you need to hire a caregiver to implement the covered services, you’ll want to make sure you understand what type of aide the insurance company will pay for. Some policies will only pay for licensed caregivers working for an agency, while others pay for personal care aides. 

You could find yourself in a bad position if you hire someone who isn’t covered by your policy. Make sure that you’re keeping a log of all communication you have with your insurance company. 

If you believe they’re taking too long or if your claim is denied, you should hire a long-term care claims lawyer to help. 

What To Do If Your Long-Term Insurance Claim Was Denied

If your long-term insurance claim was denied, or if you believe it is taking too long for your benefits to kick in, you should consider consulting with a long-term insurance claim lawyer. Long-term insurance claim policies may not cover everything you believe that they do, and they may also have strict standards or requirements.

If you believe you were misled or didn’t fully understand your long-term care policy, an insurance claims lawyer can help you determine your next move. 

Texas Long-Term Care Insurance Lawyers

Reich & Binstock is an established law firm that handles cases involving long-term care insurance denials, undervalued payouts and eligibility requirements. We have handled many cases that involve long-term care insurance disputes over the past several decades. 

Long-term care can be stressful, expensive and difficult to understand. If you feel as if your long-term care insurance claim was unfairly denied, we can help to make sure you receive benefits to cover the costs of long-term care services.