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Navigating Long-term Care Claims: Essential Documents You'll Need

Dec 20, 2023

Insurance

Navigating Long-term Care Claims: Essential Documents You'll Need

Filing a long-term healthcare claim involves reviewing a claim packet and ensuring you have all the necessary documents. In the event you find yourself in a situation where you need to submit a claim, keep reading to learn about what you must submit to your insurance provider.

Policyholder Statement

A policyholder statement is also called a claimant's statement, a set of forms containing your basic information such as name, address, and date of birth. It also includes information on your medical history and reasons for your claim. A long-term healthcare claim generally involves a chronic illness or disabilities. To maintain a safe and independent quality of life, you should file a claim for necessary care.

Attending Physician Statement

Your primary care physician must confirm your need to file a long-term care claim. This statement may be accompanied by medical tests and doctor's notes taken during a recent meeting. Ideally, a physician has known you and monitored your health for a long time. The more familiar the physician is with your medical history, the better your chance of getting your claim approved.

Nursing Assessment and Plan of Care

A nurse at your hospital should also provide documentation of an assessment of the need for your long-term care benefits. A nursing assessment may include a diagnosis, evaluation, and a plan for maintaining good health. This assessment may include data on your vital signs and other medical data reflecting your health. Your doctor should then verify the documentation.

Provider Statement

Suppose you have already been receiving long-term care from medical professionals. In that case, each healthcare professional must complete detailed forms that verify they can provide such services. They should further advise you on options like assisted living or getting home health care. Sometimes, you may need non-medical home care, where you regularly meet with a professionally-trained caregiver.

Authorization to Release Information

You'll need this form required by the Health Insurance Portability and Accountability Act (HIPAA) so your insurer can collect and review health information about your claim. Otherwise, the insurer cannot legally process your claim. As a claimant, you or someone with power of attorney (POA) must sign the form. In the latter case, you must prove that a guardian legally represents your interests.

Before completing a long-term healthcare claim, you should review your current housing, health, and financial status. For example, avoiding unhealthy habits such as smoking should be part of your long-term plan. You should also examine your budget and ensure you can keep up with financial responsibilities. 

Get the Right Long-term Coverage with Tompkins

If you are in need of long-term care coverage, contact us at Tompkins Insurance Agencies today. Our team of experienced insurance experts can help you customize a plan for your specific healthcare needs. If you prefer to speak to us directly, call us at 1-888-261-2688

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