What is your life expectancy? What is your health history and health outlook? Do you have a spouse or family member who can care for you if needed?
No one can predict how long they will live or exactly what condition their body and mind will be in as they age. And the cost of long-term care can be staggering. Therefore, many people invest in long-term care insurance.
People pay premiums to have a long-term care insurance policy that will cover their care in a facility that is not an acute-care hospital. That includes nursing homes, residential care facilities, assisted living facilities, and skilled nursing facilities. It also includes home care including home health care, adult day care, hospice services, or respite care.
But the sad reality is that when people need long-term care, and they file claims for long-term care benefits, there is a lot of red tape and the claims are sometimes delayed or denied by the insurer. Insurance companies are looking to make money, and adjusters will scrutinize the claims, trying to find reasons to not pay out the benefits to the policyholder.
Here are some of the common reasons insurance companies use to delay and deny claims:
- Ineligible Care Provider. If the insured person needs a nursing home or assisted living facility, make sure it meets the criteria of that person’s policy. The policy might state that the facility must have a specific license and the appropriate personnel and care.
- No Prior Hospitalization. Sometimes called “the gatekeeper provision,” this often appears in older policies. It requires that a policyholder have a hospitalization, a nursing home stay, or both before claims would be paid. Most states though have outlawed these provisions for many years.
- No Benefits for Personal Care. Insurance companies may say they won’t pay benefits for personal care like light housekeeping or running errands for the policyholder.
- Failure to Pay Claims Due to Cognitive Impairment. A policyholder may have some cognitive/memory issues and forget to pay their policy premiums for a little while. But in most states, you have a grace period of up to 5 months before a policy can lapse because premiums weren’t paid. If you can get a physician to state that during that time, the policyholder was impaired, the insurer will reinstate the policy.
Those a just a few of the reasons given by insurance companies. If you or a loved one has been denied long-term care benefits, please reach out to us. The cases we get involved with are when their are medical bills in the six figures that aren’t being covered. We can help you sort through the red tape, show the insurance company that you mean business, and fight for your rightful benefits.
You do not pay anything upfront. The experienced, reputable attorneys that handle these cases only take a fee if they win a settlement for you. Contact us at 312-346-5320 if you want to discuss a case.