The insurance company should provide forms and notify you of other information necessary to submit a claim. Such forms and information include the following:

1. Policyholder Statement in which basic information is provided about you, the basis of your claim, and the care you have been receiving, if any.
2. Attending Physician’s Statement in which your doctor describes why the care is needed. The doctor may also need to provide recent medical records.
3. Assessment and Care Plan. This may be handled in a number of ways depending on the insurance company. The insurance company may require that the assessment be completed by the treating physician, a healthcare provider at the facility, or an individual selected by the insurance company to meet with you and conduct the assessment. Once the assessment is complete, the Care Plan will be developed, which directs the level of care required for the individual. If an individual’s claim is based on cognitive deficits, the assessment may require neuropsychological testing.
4. Provider Statement to demonstrate that the provider is qualified to deliver the services necessary. The provider may need to supply copies of certifications or licenses. Many policies will not permit family members to be paid to provide care. It is crucial that someone who fully understands insurance policies reads and interprets the pertinent policy terms before a claim is made.
5. Authorization to Release Information. This allows the insurance company to obtain pertinent medical records related to the physical or mental condition leading to the required care.

The Insurance Company will likely complete a telephone interview to review the information submitted as part of the claim. If the claim submission process is taking too long or the insurance company appears to be creating unnecessary and unreasonable hurdles to obtaining benefits, reach out to a long-term care insurance attorney to review the situation.

There are many types of providers of personal care services, and those services may be provided in a number of different settings, as detailed below.

• At-home care. Some policies allow a family member to provide the care while other policies require a professional caregiver. The policy may provide the option for a family member to become a certified caregiver. There are numerous home health care agencies that have qualified individuals to provide the necessary care at home.
• Adult day care is non-residential care that provides planned social activities for individuals who require supervision during the day, perhaps, while a family member is working.
• Assisted living facilities provide housing, meals and planned social activities and offer various levels of care that are customized to the individual’s needs.
• Nursing home / skilled nursing facilities provide care for those individuals who require the highest level of self-care, which oftentimes includes medical care.