The first step to file a long term care claim for insurance coverage is to contact the insurance company and follow their process for opening a claim. Most long-term care insurance companies post claim packets explaining how to file a long term care claim and you can download it from their websites. Or they’ll have online claim forms, provide a phone number, or send a packet by mail to help you file a long term care claim.
Typically, to file a long term care claim, the long-term care insurance company will need the name of the beneficiary, the policy number, the reason for opening a claim and in some cases, an assessment by a Registered Nurse and/or a form signed by the beneficiary’s physician.
Each long-term care policy has stated rules for when a person can file a long term care claim. For example, in the case of memory loss, defined as mild-to-severe cognitive impairment, the reason will typically be for “constant safety monitoring.” This means the person may be physically very independent, but due to memory issues, must have supervision to avoid wandering or lack of safety in the home.
For those beneficiaries who are facing a loss in physical independence due to age, an accident or disease process, the requirement may be that the beneficiary needs help with at least two or three activities of daily living, or ADLs. Activities of daily living often include bathing, dressing, ambulation, transferring, toileting and feeding. The level of assistance required may be just someone “standing by” close in case help is needed up to “full assist,” meaning a caregiver provides hands on assistance to accomplish the ADL.
In order to get the invoices paid by the long-term care insurance, the care may need to be provided by a licensed home health agency or home care agency, which provides a copy of its license and W9 to the long-term care insurance company, in addition to providing proof of worker’s compensation insurance. In addition, the invoice must be submitted to the long-term care insurance company along with daily chart notes, proving that the care needed was provided.
An in-home care client may choose to pay for the care directly and be reimbursed by the long-term care company, or the client may want to sign an “Assignment of Benefits” form. This allows the agency to be paid directly by the long-term care insurance company.
At Home Nursing Care, Inc. is very experienced with helping our clients open, process and get coverage with their long-term care policy. Our RNs conduct assessments, create a full care plan, and supervise the home care being provided. We submit invoices and care notes every other week to the long-term care insurance companies on behalf of our clients at no charge. We take assignment of benefits when requested as well.
There is also a service that can help with how to file a long term care claim. Click here to meet Linda Jahnke and learn about her team.
Here are links to several long term care insurance companies for more information about opening claims. We’ve posted their claims packets when available.
Brighthouse Financial Long Term Care – Download Claim Process Info Here
CalPERS Long Term Care – Download Claim Package Here
Continental General Long Term Care
John Hancock Life Insurance Company – Download Claims Overview Here
Lincoln Financial Long Term Care – Download Claim Packet Here
Mutual of Omaha Long Term Care
NY Life Insurance Company – Long Term Care
Northwestern Mutual Long Term Care
Senior Health Insurance Company of Pennsylvania – Download Claim Info Packet Here
Transamerica Long Term Care – Download Explanation Packet Here