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Life Health > Long-Term Care Planning

A claim is filed. Now what?

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Q: What is the agent’s role when clients go on a claim?

A: Unfortunately, I just had a personal experience with a home health-care claim for my mother, a widow aged 90. To complicate the situation, I live 1,000 miles away from my hometown, where my mother still resides.

When my brother, who lives 75 minutes from her, took her to the hospital, she was diagnosed with pneumonia and admitted. Five days later, her doctor told her that she had recovered enough so that Medicare would not pay for the hospital and she had to leave that day. Meanwhile, she was still very weak. The result was total panic on her part: Where would she go? Who would take care of her?

Here are the lessons I learned

1) I reassured her that it was not her decision alone and not to stress. I, my brother and his wife would help. Further, we could hire a care coordinator if needed. Make sure your clients are aware of the value of a care coordinator. They should not be pressured by busy doctors and
hospital personnel to make a snap decision.

2) Since my husband was her LTCI agent, I knew the name of the carrier and the telephone number. However, I didn’t know her daily benefit or policy number. Contact your clients and ask them who should have a copy of their policy’s schedule page (such as children, siblings or attorney). You can also use this opportunity to get referrals and develop prospects and centers of influence.

3) I always advise agents to stay out of the claim. I followed my own advice and that definitely worked. Help the family contact the claims department and let them take care of the claim, not you.

4) My sister-in-law Nancy made the initial arrangements with the agency to send a companion. My only question was whether the companion was a certified nurse’s aide, which her policy required. (Answer–yes.) My mom needed around-the-clock care, so the agency scheduled two 12-hour shifts. The daily cost was $440, which seemed staggering at first until I realized it was about $18 an hour. Let the claims department make sure that the HHC agency and the aide qualify for payment and that you know the type of care the agency is providing.

5) The carrier’s intake specialist asked if my mother had a financial power of attorney (and to fax it). I didn’t know, and it wasn’t a good time to ask my mother. Suggest to your clients that they obtain a financial power of attorney and then give a copy to their children.

6) Being a long distance caregiver is tough. The guilt and lack of control are stressful. I do have peace of mind that my Mom has a policy, the claims department is working with the family and my mother is getting the care she needs.


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