Understanding Long-Term Care Insurance

Industry leaders predict that the use of Long-Term Care Insurance (LTCI) for home care will keep increasing as the nation’s older population continues to grow. Jesse Slome, director of the American Association for Long-Term Care Insurance (AALTCI), explains that “most long-term care insurance claims begin and end in the home, wherever home may be… and having a long-term care insurance policy can help pay for some or even the entire cost of home care services.”

While financial support helps offset all or some of the cost of home care services, the complex rules of LTCI plans can be difficult to understand and cause more headaches than relief. At Family & Nursing Care, we recognize this challenge and have made it a mission to simplify the reimbursement experience by having a department, led by our LTCI Manager, Karin Martinez, to handle all clients’ LTCI questions and concerns.

An in-house expert on everything LTCI, Martinez is a staunch client advocate. We spoke with her to find out exactly how she fights for proper coverage/reimbursement and strategically assesses each client’s LTCI policy to ensure that they are reaping their policy benefits to the fullest extent, allowing family members to concentrate on their loved ones.

What do you do in your role as Long-Term Care Insurance Manager?

“LTCI policies can be challenging to navigate successfully (it is insurance!). My goal is to make sure our clients know they have someone on their side to help them through every step of the process. One of the ways we help the most is by always facilitating a conference call with the client/family member and their LTCI company to help ensure they have a full understanding of their policy’s criteria, benefits, and policy holder responsibilities for a smooth experience with the reimbursement claims process. From that point on, I offer as much or as little support as they need.

In addition to educating families about various nuances in their LTCI policies and assisting with the complex paperwork, I often see myself as an interpreter. During calls with LTCI companies, the language being used is very much “insurance-speak” that not every lay person may understand. It’s my job to then translate what they say into understandable terms, or give real life examples, until I’m confident that the client’s concerns and questions have been answered fully.” 

In what way do you think you bring the most value to your clients?

“The more I help clients navigate the complicated LTCI system, the more I realize that they really needed an advocate—it’s more than just making one call to the LTCI company with the client/family to understand the policy benefits—it’s about seeing the whole process through so the families get their reimbursements to which they are entitled.

I’ve seen people get so frustrated and overwhelmed that they just want to give up dealing with all the paperwork, the requirements, and the inevitable waiting period of their LTCI claims reimbursement. I know our clients have paid much of their hard-earned money into their policies and this inspires me to support them and encourage them to stay the course. Another value is that, with my support, families have more time to focus on the most important thing—their loved one.”

What are some of the specific ways you go above and beyond for your clients?

“I am proactive in submitting records to LTCI companies. I also help clients identify other benefits outside of home care in their LTCI policies (e.g., care manager service, Assisted Living or Nursing Home, home modification, lifeline benefits, and more). I also provide support with appealing claim denials. And finally, we offer an Assignment of Benefits (AOB) arrangement for Family & Nursing Care Select clients, where we invoice and get payment directly from the LTCI company, which means Family & Nursing Care Select takes on the financial risk of receiving reimbursement, rather than the client.”

What’s one of your favorite stories about a client you have helped?

“Recently, we had a client who didn’t want to file a LTCI claim at all. He didn’t think his policy would qualify and he didn’t think he would meet the criteria for his elimination.  I convinced him that it may be worth a try…perhaps his days of care would count towards that elimination period so that he would be closer to getting his LTCI benefit in the future when he needed more care. On our conference call with the LTCI company, we ended up finding out that his elimination period would be waived for home care services. He did qualify and ended up getting $11,000 back for the 6 weeks of care. This is money he never expected to receive.”