Claim basics

    How a long-term care insurance claim actually works

    A long-term care claim generally moves through eight stages: notify the carrier, complete the claim packet, obtain practitioner certification, complete a care assessment, agree a plan of care, establish provider eligibility, satisfy the elimination period, then submit itemized invoices for ongoing reimbursement. The specific steps, order, and documentation are set by the individual policy.

    The eight stages, in order

    • 1. Notify the carrier or administrator that care is needed and open a claim.
    • 2. Complete the claim packet, including the authorization that lets the carrier speak with whoever is managing the file.
    • 3. Obtain certification from a physician or licensed health care practitioner describing the need for care.
    • 4. Complete the care assessment used to test the policy’s benefit trigger.
    • 5. Agree a written plan of care describing the services to be delivered.
    • 6. Establish provider eligibility — the agency supplies licensing, tax, and business documentation.
    • 7. Satisfy the elimination period, if the policy has one.
    • 8. Submit itemized invoices on the carrier’s cycle and respond to recertification requests.

    What the family does and what we do

    Families own the relationship with the carrier: opening the claim, signing authorizations, and making decisions. We own the provider side: licensing documentation, care records, shift notes, and invoices detailed enough to withstand review.

    Where written authorization is in place, we can respond to documentation requests directly, which spares an adult child from relaying questions between an insurer and a caregiver schedule.

    The four things that most often delay a claim

    • No authorization on file, so the carrier will not speak with the adult child managing the claim.
    • Provider documentation submitted weeks after care began.
    • Invoices without shift-level detail, returned for revision.
    • Months of invoices batched together instead of billed on the carrier’s cycle.

    Starting care before the claim is decided

    Most families cannot wait. Care usually begins privately while the claim is reviewed, and many policies have an elimination period that has to be served before benefits are payable anyway. What matters is that every shift is documented from the first day so nothing has to be reconstructed later. Whether privately paid days count toward the elimination period is determined by the policy.

    For families

    I have a policy and need home care

    Request a no-cost policy review conversation, or call and speak with someone who has handled long-term care documentation before.

    For professionals

    Refer a policyholder

    Agents, advisors, fiduciaries, attorneys, care managers, and discharge planners can send a referral and receive provider documentation for the file.

    Common questions

    Keep reading

    Carrier guides

    Official resources

    Contact the company directly for current claim forms and instructions.

    Information last reviewed: August 2026

    Important disclosure
    Golden Age Companions is not affiliated with, endorsed by, sponsored by, or an agent of any insurance carrier, program, or administrator named on this site. Carrier and program names are used only to identify the policy a family may hold. Coverage, eligibility, benefit amounts, provider approval, elimination periods, and reimbursement are determined solely by the individual policy and its administrator. Golden Age Companions provides non-medical home care and administrative claim support; it does not sell insurance or provide insurance, legal, tax, or financial advice.
    Call (949) 630-0487Book