Using Long-Term Care Insurance

What Long-Term Care Insurance Covers

Long-term care insurance (LTCi) policies vary widely, but most cover in-home, non-medical care like what CVHC provides once the policyholder meets the "benefit trigger." Typical triggers are:

• Needing substantial help with two or more activities of daily living (ADLs) — bathing, dressing, toileting, transferring, continence, eating
• Having a cognitive impairment (dementia, Alzheimer's) that requires supervision

Once the trigger is met and the "elimination period" (usually 30–90 days) is served, the policy starts paying toward covered home care services.

How We Work With LTC Policies

We bill most carriers directly

For most major LTCi carriers, we can bill the policy directly — you don't pay out of pocket and wait to be reimbursed. We verify benefits up front and handle the ongoing claims paperwork.

We handle the documentation

LTCi carriers require detailed visit documentation to pay claims: who was there, when, what was done, and how it matches the care plan. Our EVV system (Sandata) and internal visit notes make this clean and consistent, so claims don't get denied or delayed for paperwork reasons.

We coordinate with the insurance-designated care manager

Some policies require a third-party care manager to assess the client and approve the plan. We're used to working with these care managers and will coordinate with them as part of setting up services.

Filing Your Claim: The Process

1. Call your LTCi carrier and tell them you want to file a claim for home care benefits. They'll send you a claims packet.
2. Schedule a benefit assessment — most policies require an assessment (either in person or by phone) to confirm the ADL or cognitive triggers are met.
3. Start your elimination period — if your policy has a 30/60/90-day waiting period, some policies let private-pay home care hours count toward it. Others require the trigger to be met without yet receiving benefits.
4. Carrier approves the claim — you'll get a letter with the approved daily benefit and any conditions.
5. Care begins — CVHC documents visits, bills the carrier, and you receive the service without out-of-pocket exchange.

Questions About Your Policy?

If you're not sure what your policy covers or how to file a claim, bring your policy documents to your free consultation. We've read a lot of LTCi policies over the years and can usually point you to the key provisions — daily benefit, elimination period, coverage for companion care, home modifications, etc.

We're not insurance agents, and we don't sell policies. But we do help our clients actually use the ones they already have.