Q&A Topics

Friday, January 27, 2012 8:33:41 AM

If I buy long-term care insurance, how does the claims process work? Is it similar to the claims process for health insurance?

No matter what type of insurance claim is involved, most insurance policies provide reimbursement for costs incurred the policyholder keeps receipts and submits them to the insurance company for payment. Of course, the insurance company first will determine whether the policyholder meets the benefit eligibility triggers that have been set out in the policy.

When filing a long-term care insurance claim, or any insurance claim, here are some steps you should follow:

• Have a copy of your insurance policy on hand, then call the insurance agent who sold you the policy. Let your agent know that you're ready to tap into the policy's benefits and that you'd like to review the policy's terms.

• Be aware of your policy's predetermined elimination period. During this time, you may have to pay for expenses out of pocket.

• Remember that all appropriate forms must be filled out before an insurance company will act on your claim.

• Keep in mind that all care providers involved may have to submit their records and documentation.

• Hang on to a copy of all correspondence and documents. Take notes regarding people you've spoken to and what they said. Jot down times, dates and contact information.

• Keep the lines of communication open with your insurance agent and insurance company. That way, you know how your claim is progressing and whether all of the requested information has been submitted.

Keep in mind that claims sometimes denied or appealed. Try to stay on top of each step as the claim goes through its various stages. If the customer service is not to your satisfaction, you may want to register a complaint with your state insurance department.