How do I make a long-term care insurance claim?

Before you can file a claim for long-term care insurance benefits, you will want to make sure that you meet your policy’s elimination period and at least one of its benefits triggers.

An elimination period can be thought of as a deductible measured in time instead of money. It’s a waiting period between when an illness or disability begins and when you start receiving benefits. During the elimination period, you are responsible for covering any expenses related to your care. Most long-term care insurance policies have an elimination period that lasts 30, 60 or 90 days.

There are usually two events that trigger long-term care insurance benefits. They are experiencing either severe cognitive impairment or being unable to perform two activities of daily living such as dressing or feeding yourself.

How to File a Long-Term Care Insurance Claim

Once you meet the elimination period and you (or your caretaker) believe you experienced a long-term care insurance benefits triggering event, it’s best to file your claim as soon as possible. This will help ensure timely payment of benefits if you do qualify.

These are the general steps to take when filing a claim for long-term care insurance:

  • Contact the insurance company to get a claim packet. If you worked with an insurance advisor to get long-term care insurance, he or she will be able to help you start the process. Some companies’ claim forms can be filled out online.
  • Fill out the claim packet. Claim forms vary by insurer, but will usually include:
    • Policyholder statement: This form will ask information about you, why you’re submitting a claim and what kind of care you’ve received so far.
    • Attending physician statement: Your doctor fills out this form. It will ask about test results, medical notes and other documentation showing that care is necessary.
    • Nursing assessment and plan of care: A nurse usually fills this section out. In it, he or she will write an assessment of your current condition and a detailed plan of care that they recommend.
    • Provider statement: If you’re already receiving care, the provider will need to fill out a form showing that they are qualified to deliver that care. The form may also ask for proof of licensure and certifications.
    • Authorization to release information: This form lets the insurer obtain any needed medical documentation to process the claim. It ensures that the insurer is in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
  • Attend a phone interview. The insurer will usually contact you by phone to go over the information in the claim packet.
  • Wait for a response. You can expect to receive a response in about 30 days or so. During this time, the insurer may reach out if they have any additional questions.

If your claim is approved, the insurer will either pay the care facility or provider directly or reimburse you each month for covered expenses that you paid out of pocket.

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