Often times when clients call for service they explain they have a long term care policy but have not started the claim process yet. I try to provide a guideline for them because the process is very taxing and sometimes the original insurance agent who sold them the policy is nowhere to be found. If the insured or their family member calls the 800 number for the claims dept unprepared, they usually get the run around. So below I have listed some important steps and questions that can help make the process easier for the caregiver:
- Call the claims dept. and tell them you are currently the caregiver for your loved one and want to start the claims process:
- Ask about the elimination period (out of pocket expenses) and the max daily/weekly benefit amount
- Have them define how many and which ADLs the insured needs to be assisted with for reimbursement
- If the insured has recently been in a SNF/Rehab, see if it counts toward the elimination period
- I possible, provide them with the contact information with the agency you are planning on using for services
- They will usually send a letter requesting information from you- a form from their primary physician (PCP), etc. –MAKE COPIES OF EVERYTHING YOU SEND!
- Ask about the process for reimbursing
i. What days they cut the check on.
ii. What documentation they require
- Ask if they reimburse for mileage
- They will assign someone to the claim- be sure to get their name and number
- (Optional) Ask if they have an Assignment of Benefits, a form that will allow the care agency to be reimbursed directly instead of the family paying the bill and waiting to be reimbursed.
By no means am I inferring that all Long Term Care insurance companies are the bad guys, they simply just have a lot of claims to process. I have experienced that for the process to go smoothly the insured client and/or their family caregiver have to be their own advocate.