INSURANCE


Make Sure Your Insurer Pays Up

Virgil and Mary Rickard bought long-term-care insurance policies in 1998, just after their 70th birthdays. It turned out to be a wise decision.

Mary cared for Virgil at home for several years after he was diagnosed with dementia and Parkinson's disease, but last year she finally had to move him into a nursing home. That's when she filed a claim for long-term-care insurance benefits. Despite her background as a bookkeeper and her keen eye for detail, Mary was soon overwhelmed by the paperwork and asked her daughter for help.

In many cases, getting a long-term-care claim approved is the easy part. It's the ongoing paperwork that drives families crazy, especially if you have to submit home-care reports with details of daily care. Mary's story has a happy ending, but it provides a cautionary tale for policyholders -- and their caregivers.

For starters, keep in mind that the person who files a claim on your behalf ten or 20 years from now may not know the details of your policy. Make it easy on your future caregivers by giving them a copy of your policy along with a cover letter specifying the important details: policy number, the people to contact about claims (both the contact person at the company and the agent), key information about how to qualify for coverage, and how long the waiting period lasts before benefits begin.

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That's just one of the strategies to get the most out of your long-term-care policy. We interviewed insurance agents, claims specialists and family caregivers to create the following guide to filing claims.

Ask for Assistance
Initially, Mary Rickard wanted to review every bill from the nursing home before it went to the insurer so she could spot any errors. But that meant she had to pay the bills out of her own pocket before getting reimbursed by the insurer -- writing checks for more than $4,000 every month. "You have a long-term-care policy and assume everything is covered," says Mary's daughter, Linda Swaim. "You don't think there's going to be a reimbursement issue."

But even Swaim, a nurse who specializes in worker's compensation claims, was overwhelmed by the complicated and time-consuming claims process. Some of the nursing home's charges were covered by the policy, while others were not. And sometimes the facility or insurer lost crucial paperwork, delaying reimbursement checks.

Swaim finally called her family's long-term-care insurance agent, Betty Doll, to ask whether there was any way to streamline the process. Doll helped her arrange direct billing between the nursing home and the insurer. (This is called "assignment of benefits.") That freed Mary to spend her days with Virgil in the nursing home a few miles from where she lives in Winston-Salem, N.C., rather than sifting through paperwork.

Some long-term-care agents will help with claims paperwork, so ask about that when you're buying a policy. "We always tell our clients to let us handle the claim to make sure it is done right," says Karl Kim, of Retirement Planning Advisors, in Cerritos, Cal. His staff gathers the paperwork for the client, follows up with phone calls to the claims department and can assist family members with monthly invoices.

Several insurers -- such as John Hancock, MetLife and Genworth -- now provide a "care coordinator" for long-term-care claims. The coordinator -- often a nurse or a social worker -- can answer questions about claims, initiate the paperwork and guide you through the claims process. "It's never too early to contact a care coordinator," says David Acselrod, vice-president and product manager for long-term care with MetLife.

It helps to call when you first suspect that your relative will need care, even if it's long before he or she will become eligible for benefits. The care coordinator can explain what needs to happen to qualify for benefits and which types of facilities and caregivers you can use.

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