How to File a LTC Claim

Communication is key to an effective claims process. It begins well before the claim takes place. Make certain that appropriate family members and advisors know that the long term care insurance policy exists. Give them a copy of the policy schedule page or preferably a copy of the entire policy as well as the business card of the agent who sold you the policy or the contact person/benefit department for your employer if a group plan through your employer.

The claims department phone numbers for the major long term care insurance carriers are listed below.

The claim process may vary from company to company but generally the following applies:

1. Designate individual who will be in charge. This person must have written authorization to act on your behalf.
2. Contact the insurance company as soon as you think care might be needed. Ask them what their requirements are if in-home care is likely. The skill level or certification or license requirements may be central to having claims paid.
   Have the insurance company send out relevant forms and begin claim process. Note: Your insurance agent needs a signed and dated authorization in order to speak to Insurance Company, for any reason, on your behalf.
3. Most Claims require that a plan of care, detailing actual care that is needed, be submitted. Ascertain whether the company will handle the Assessment and Plan of Care or if the individual has the choice to hire a social worker or nurse to provide this service.
4. Claim Forms - Make certain physician's notes include reference to need for help with activities of daily living (ADL's) or due to cognitive impairment.
5. Have a duplicate copy of all forms prior to sending originals to insurance company.
6. Understand that claims usually are reimbursed once a month. The first claim usually is paid about one month after the claim is received by the insurance company.
7. Care Coordination - claim time can be very stressful to the insured as well as to family members. In order to ease the transition, many LTC carriers have provided for care coordination in their policies. Since health and safety are primary concerns, the care coordinator can act immediately, if necessary, to assess the situation and draw up a plan of care. The care coordinator may assist in arranging for services and may help with the claim. They follow up as necessary to monitor and review the plan of care.