Long-term care insurance has been available for over thirty years.  It is becoming increasingly popular for persons to purchase long-term care insurance as they begin to prepare for their potential care needs in the future.  Typically, Long-Term Care insurance is attractive to those with assets over $50,000.  Those with assets less than $50,000 would generally spend those assets quickly should a medical need arise and potentially qualify for Medicaid.  

Long-Term Care Insurance

There are over 300 Long-Term Care insurance providers.  Most policies are comprehensive, meaning that services may be provided in a number of settings, including the resident’s home, a Hospice or respite location, a specialty care facility such as an Alzheimer’s care Center, an Assisted Living (AL), Skilled Nursing Facility (SNF) or a Continuing Care Retirement Community (CCRC). Each Long-Term Care Insurance carrier has its own products and definitions that may affect payment. They do not all follow the same definitions as CMS/Medicare.  Some carriers may require pre-approval of services or the involvement of a care manager.  Most policies pay costs up to a pre-set daily limit until a cap is reached.

Billing Long-Term Care Insurance

Most Skilled Nursing Facilities (SNFs), Assisted Living (AL) and Continuing Care Retirement Communities (CCRCs) do not bill a Long-Term Insurance carrier directly.  Rather, they will bill the services as private pay.  They may also provide a statement including itemized charges to the resident or responsible party that can be submitted to the Long-Term Care Insurance carrier by the resident/family member in order that they would receive reimbursement.  The statement may be attached to a claim form that would typically be completed by the resident or responsible party.  If the Long-Term Care Insurance carrier requires any additional information, they will likely send a request for additional information.  This can be submitted to the SNF, AL or CCRC as appropriate.  Generally, it may include a request for some clinical documentation of diagnoses, nursing services provided, etc.

Your billing software may allow for your business office to set a separate category for Long-Term Care Insurance within the Private Pay category.  This will allow you to track any charges separately just for informational purposes only.  The resident/responsible party should fully understand that the charges are considered Private Pay and due each month according to the payment terms of the agreements signed. As a customer service, it is beneficial to assist the resident/responsible party by providing extra copies of the monthly statement, itemized charges, etc. if requested.  Long-Term Care Insurance is becoming increasingly popular for baby boomers.  You will likely see more residents, particularly those in an AL or CCRC setting utilizing these policies in the future.