Once it has been decided that you or a loved one are eligible for long-term care benefits, you need to fill out and file a claim packet containing several necessary documents. These documents need to be filed for the insurance company to review, in order to be properly considered, and hopefully approved, for long-term care benefits.
Even though insurance company’s claim documents may vary, a typical claim packet will contain the following five documents:
- Policyholder Statement This is also known as the insured’s or claimant’s statement, and it is a set of forms that required filling out the claimant’s basic information (name, address, date of birth, etc.). It also requires detailing the reasons for the claim, including which ADL’s are unable to be performed. It also may include information pertaining to hospitalization and medical history. These forms must be personally signed by the claimant, or their respective legal representation.
- Attending Physician Statement This is a form that must be personally filled out by the claimant’s primary care physician, who must confirm the medical necessity of their long-term care. Documents that could be included with this form could be specific medical test results, medical records, physician notes during an office visit, or any other supporting documentation.
- Nursing Assessment and Plan of Care A nurse employed with the claimant’s medical care provider should conduct an assessment, including vital sign and medical records. The nurse must also prescribe a specific plan of care, detailing the type of care required by the claimant. These forms may also require verification from a physician.
- Provider Statement If the claimant is already receiving long-term care, each care provider must fill out forms that verify that they are capable of providing the care services detailed by the plan of care forms. They may also need to submit proof of certification, showing that they are properly licensed to provide long-term care.
- Authorization to Release Information This form is to comply with the Health Insurance Portability and Accountability Act (HIPAA), which permits the insurance company to collect and review confidential medical records and related healthcare documentation pertaining to the policyholder’s claim. This form must be filled out in order for the insurance company to be able to legally process the claim. The claimant must personally sign this form, but if it instead signed by someone else on their behalf, then a power of attorney (POA) or guardianship documentation must be included as well.
