While our team is available to assist you with your Long-Term Insurance claim, we are happy to provide an overview of the process here:

1. Call your insurer
   “Hello, I am __________, I would like to file a claim.” This will prompt the insurance company to send you an initiation packet. Within the initiation packet, you will find a range of documents which include intake forms, physician documentation, a range of authorization forms, etc. This must be faxed to the insurance company by the client or a long-term care administrator. If you are using LifeWorx as a provider, you must list us under your provider of care in your claim.
2. Prove the recipient’s need
   Often insurance companies want claimants to prove that they need care to perform two or three activities of daily living (ADL) such as bathing, dressing, feeding, toileting, transferring, or incontinence. This can be done with a licensed health care provider confirming in writing the details of a patient’s care needs. When you speak with the insurance company, it is important to make it clear that you have documentation proving need from a physician and/or RN assessment. The insurer should also have a written demand to call the patient’s advocate or information only.
3. Determine the elimination period
   This is the number of days before benefits kick in. In the meantime, it is the family or client’s responsibility to pay. Elimination periods can range from 20 to 60 or even 100 days. The way an insurance company counts days can vary as well. Normally they count based on “calendar days,” pay for services X amount of days after you file a claim, or the company certifies you are eligible for coverage. Other insurance companies count by “service days.” This is when the insurer counts the days a caregiver visits the patient toward their waiting period. Some insurance companies will eliminate this period altogether. It can get tricky if your claim is rejected because the caregiver was not certified, you did not go through an agency, or have an assessment done prior to the elimination (waiting) period.
4. Check requirements
   Before picking a caregiver, it is important to study the fine details of your insurer’s coverage. Many policies require a licensed caregiver to aide your loved one and some insist that an agency provide the care and certify the need. If your claim is rejected, work with a LTCI insurance expert.