Rachel O’Brien and Kemeia White
Long-Term Care Insurance
Don’t Postpone Filing A Claim
It’s a story Rachel O’Brien has seen too many times.
A family calls Cambridge Caregivers after their father is diagnosed with cancer. He’s still at home, still fighting, but needs a little help a few days a week. The family member mentions, almost in passing, that Dad has a long-term care insurance policy.
“But we’re going to hold off on claiming that, until he really needs it,” they say.
But life doesn’t always follow a plan. Months pass, and suddenly Dad’s condition takes a turn for the worse. He’s placed in hospice care, and not long after, he passes away.
The LTC policy, the one Dad paid into so diligently for so many years, was never used.
“This is a situation I’ve witnessed many times,” says Rachel, who is a Community Liaison in Cambridge Caregivers’ Fort Worth office. “Families think, ‘Let’s hold onto that policy until we really need it.’ But nobody has a crystal ball. The client’s condition changes quickly, and then they run out of time.”
How ‘Holding Off’ Backfires
Many families delay filing a claim for understandable reasons. They worry about:
- Running out of benefits too soon
- “Saving” coverage for a later stage of decline, when more intensive care is needed
- Not fully understanding how the policy works
But waiting can create unintended consequences.
“The sooner the family initiates the process of filing a claim, the better,” says Kemeia White, LTC Insurance Specialist in Dallas. “Most policies have limitations of some kind, whether it’s a maximum daily benefit, or a monthly cap, or a lifetime maximum. You want to understand those from the beginning, so that you can start using what’s available.”
Just as important: the process itself takes time.
Understand the ‘Elimination Period’
Most long-term care insurance policies include what’s called an elimination period—typically 30, 60 or 90 days. During that time, families must pay for care out of pocket before the policy begins reimbursing.
But here’s where confusion often arises.
“Say the elimination period is 90 days; that isn’t always as simple as people think,” Rachel explains. “Sometimes it’s 90 calendar days after the need arises. Sometimes it’s 90 consecutive days of actual care. If you’re only receiving care a few days a week, that period can stretch much longer.”
The most important thing to understand: if a claim has not been filed, the clock hasn’t started ticking. Waiting, especially in a situation where the insured person’s health is declining, can mean the benefit never kicks in at all.
Another key point: families can’t simply decide to use long-term care insurance.
While policies do vary – a lot – typically they require a certification from a physician, and proof that the individual needs help with at least two Activities of Daily Living (ADLs), such as bathing, dressing or mobility.
“You can’t just say, ‘I want a helper in the house,’” Rachel says. “A doctor has to confirm the need for care, and there has to be documentation.”
That documentation, including ongoing care notes noting the types of services provided, becomes part of the claims process.
How Cambridge Can Help
At Cambridge Caregivers, our team works closely with families navigating long-term care insurance. Members of our team can:
- Provide care plans and documentation
- Submit care notes and invoices
- Help organize required paperwork
But there’s one thing our team cannot do: They cannot initiate the claim.
“The client or family has to call the insurance company and open the claim,” Kemeia explains. “We can assist with the documentation and the process, but the family must take that first step.”
Both Kemeia and Rachel note their advice to file a claim as soon as possible isn’t about bringing in business—it’s about helping families make the most of a resource they already have.
“It’s actually simpler for us when families pay privately, out of their own pockets,” Rachel says. “There’s less paperwork, less back-and-forth. But we hate seeing families not use something they’ve paid into for years.”
“And we’re glad to help with that process,” Kemeia adds.
While Cambridge can assist clients with the filing process, clients continue to pay Cambridge for their care out of pocket, even after insurance kicks in.
“The long-term care insurance provider reimburses the client directly, as we do not accept direct payments from insurance companies,” Kemeia says.
Start Early
Another factor many underestimate: the difficulty and the time required to complete the claims process. Even after a claim is initiated, it doesn’t move overnight.
“Filing a claim for long-term care insurance is a lengthy process,” Kemeia says.
Insurance companies may request medical records, care plans, proof of services and ongoing documentation. There may be delays, follow-ups and repeated submissions.
The bottom line: if you have LTC insurance, don’t hold off until you think your loved one really needs it. Understand when and how your loved one qualifies. When that time comes, the sooner you get started, the better.
Long-term care insurance is designed to support families during some of life’s most challenging moments. But it only works if it’s activated—and activated in time. If your loved one has a policy, find it, read it, and ask questions if anything is unclear.
“We’re glad to help,” says Rachel. “If you can get a copy of your policy to us, we’ll take a look and do our best to help you understand how it works.”