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Long Term Care Insurance Claims Processing in Vestavia, AL

When the time comes for you to begin weighing the benefits of long-term residential care either for yourself or for a senior family member or loved one, you’ll probably have many questions that you’ll need answered before you’re comfortable enough to make a decision. Amada Senior Care in Vestavia, AL, can help you review the options offered by your current long-term care insurance policy. Our financial consultant will be happy to let you know which one of our options is covered by your existing plan. We can also help you plan to meet your family’s future needs.

We understand the complexities of assisted living senior placement and can explain them to you in clear, concise language. We’ll clarify any terminology or concepts that are unfamiliar to you.

Looking Ahead to the Future

At Amada Senior Care, we appreciate the value of careful planning. We want to help you get the most out of the long-term care insurance policy you’ve invested in. Our insurance advisers work with clients in every part of Birmingham as well as Vestavia. Call today to schedule a consultation.

Below are some important things you should know about your long term care insurance policy.

1. WHAT IS THE ELIMINATION PERIOD ON YOUR POLICY?

0, 30, 60, 90, or 100 day period?

The elimination period is like a deductible where you are responsible for paying the full portion until your coverage.

Tip - The elimination period is calculated either by calendar days or actual days of care. Find out which your plan covers. You can start care 3-4 days a week for 4-5 hours a day to minimize your out-of-pocket expenses during your elimination period and expand care as needed once the elimination period ends and coverage has kicked in.

Tip - Activate your policy as soon as you qualify for care. Most families have a tendency to wait too long to activate the policy and end up paying for full-time care during their elimination period. If care is initiated early, it will allow you to pay for minimal care before needs become overwhelming.

2. WHAT IS THE MAXIMUM DAILY BENEFIT?

Usually $80-$300 a day

Maximum daily benefit is the maximum amount your policy will reimburse for each day.

Tip - Find out if your policy has an inflation rider which can significantly increase your maximum daily benefit. Also, inquire about the anniversary date on which the policy increases each year.

Tip - Ask if your policy has a waiver of premium. The waiver period suspends premium payment while the policy is in use.

3. WHAT IS THE MAXIMUM LIFETIME BENEFIT?

Days or $

Most policies state the maximum lifetime benefits in terms of days or dollars. Find out which your plan uses.

Tip - Although most plans have a maximum daily and maximum lifetime benefit, it is important to determine how those two work together. For example your policy may have a max daily benefit of $200 and max lifetime benefit of $120,000 or 600 days. If you use less than the max daily benefit ($200), does the unused portion go back into your max lifetime benefit or does that count for a day that can never be recovered?

Tip - Find out if your policy has a Restoration of Benefit. This feature enables a claimant to restore benefits if not fully maximized.

4. WHAT DOES MY POLICY COVER?

Assisted living care?

In home care (caregivers)?

Skilled nursing facilities?

Tip - Ask if your policy requires the use of a certified nurse aide (CNA) or home health aide (HHA)

5. WHAT DO I HAVE TO DO TO ACTIVATE MY LTC POLICY?

  • Call in and request a claim packet
  • Fill out the claim form and send it in
  • Make sure to list the information of the company providing care and their tax ID
  • Check to see if the policy requires a doctor to fill out a form documenting your need for care
  • Check to see if you need an assessment from a registered nurse (RN)

Tip - Ask if your policy requires the use of a certified nurse aide (CNA) or home health aide (HHA)

6. ONCE MY CLAIM IS APPROVED HOW DO I GET REIMBURSED?

To be reimbursed you need to ensure that each invoice you receive from your provider is submitted with notes documenting that assistance with ADLs is provided each day.

After determining your plan’s elimination period and maximum daily/lifetime benefits, put together a plan to optimize your policy’s benefits based on your expected length of care. Activate your claim as soon as possible to minimize your out-of-pocket expenses during the elimination period

Our Commitment To In-Home Care

Amada Senior Care is committed to enriching lives by providing nurturing, compassionate non-medical in-home care and by guiding families through the many senior housing options available for assisted living and care homes. Healthcare professionals and families look to Amada to help them navigate the complexities of the senior care system.