Long term care insurance (LTCI) Claim Denials

The promise of long-term care (LTC) insurance is clear: it’s purchased to cover the cost of extended care you may need someday.  But more and more policyholders are finding out at claim time that getting the money out of a policy can be difficult. Imprecise policy language, hours on hold, ongoing paperwork requirements, and differing regulations across state lines are among the daunting obstacles families face at claim time.

A recent article published by MarketWatch describes a man who paid the premiums for his wife’s LTC policy for twenty years. After the husband passed away, their son hired a caregiver for his mom as she battled Alzheimer’s disease. But the son was shocked when the insurance claim for that caregiver was denied on the grounds that the caregiver wasn’t qualified to perform those care services. He says it took “months of dogged efforts” to convince the insurer to pay out the benefits as expected.  It’s frustrating when a family discovers that the care they are able to line up doesn’t meet the policy requirements.  That’s just one of the problems families face – and they’re not sure how to proceed when that happens.

A trend of industry difficulty

This story isn’t an outlier. Thousands of policyholders (and their families) are learning that LTC insurers may not be prepared to pay out claims for the types of home health and other long-term care services that the family sees as critical to maintaining quality of life.

And there’s plenty more heartache to come, with the Bipartisan Policy Center estimating that three in four Americans over 40 “are not confident they will have the financial resources to pay for needed care as they age.” These adults are facing the depletion of their retirement accounts, creating financial burdens for families, and risking their health when they can’t afford care.

Finding support for your claim

As the population continues to age and more people submit claims for their LTC benefits, the system is likely to become only more difficult to navigate—especially if policyholders are trying to make sense of it on their own.

“I have talked to other people and many just give up out of frustration,” the daughter of one of our claimants told us. “WE ARE NOT GOING TO DO THAT! Thanks for hanging in there with us and offering your expertise. It is a minefield.”

If you’re in the midst of submitting or appealing an LTC claim—or if you expect to be filing one soon—Family Solutions for Care can help you get the benefits your family deserves. Read about our services or call us today at 844-858-4500!