If you’re not sure if you’re eligible to file a claim and begin receiving payments, you’ll want to ask. If you’re currently receiving care services, you’ll certainly want to initiate a claim within a couple weeks of those servicing beginning. Don’t be hesitant to check. That’s why you have the insurance.
Most companies make it fairly painless to begin the Claims process. Typically, your best first step is to call the insurance company’s Claims Department. Calling your insurance agent, or the company’s Customer Service area are also options.
The process will include the need for both you and your physician to complete claim forms. Among other things, the insurance company will most likely need to see medical records, hospital records, facility records, and any invoices for care services that have been provided.
You may also be visited by a Care Assessor, who will review your situation to determine the level of care needed.
Once your claim is approved, usually within 30 days, you’ll begin receiving benefits on a monthly basis, subject to any Elimination Period specified in your policy. The Elimination Period is like a deductible. It’s the number of days of care that you’ll personally pay for prior to the policy benefits kicking in. Your policy may, or may not, have one.
The amount of your benefits will be dictated by the type of policy you have and the limits you’ve chosen. There are two types of policies: Indemnity and Reimbursement. An Indemnity policy will pay a fixed, specified amount per day of eligible coverage, without regard for what the actual cost of care was for that day. A reimbursement policy will pay up to a fixed, specified amount per day of eligible coverage, based upon the actual cost of services provided.
If your condition should improve to the point that you no longer need care, you can stop the claim. Any unused benefits will remain in the policy and can be used for future claims.