LTC Claims Process

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LTC Claims Process

 

Is it time to begin a claim for long-term care insurance benefits? We are here to help. We will outline each step to guide you along the process.

 

When to consider initiating a Long-Term Care (LTC) claim:

You may consider filing if you:

 

If you meet the criteria above, please click here to view “Initiating a Claim.”

 

*Please note anyone can initiate a claim on your behalf but, only you or your legal representative will have access to your information. If you have a Power of Attorney acting on your behalf, additional paperwork will be required when submitting your claim to avoid any potential delays.

 

If the above criteria do not apply to you, it may not be the right time to initiate a new claim. For more information about obtaining a copy of your policy or to discuss your situation, please contact us at 888-687-0977. 

 
 

Long-Term Care Services

Long-term care service may include Home Care Services, Adult Day Care, Nursing Home, Hospice Facility or Assisted Living Facility (please refer to your policy).

Additional Paperwork

Legal Document Submission 

Address:
MetLife Long Term Care Claims
P.O. Box 14407
Lexington, KY 40512

Fax: 1-859-825-6751

Email: LTCIntake@metlife.com**

**Documents must be submitted in PDF format. Please be advised we are unable to open attachment hyperlinks to 3rd party storage sites (IE: Google Drive & iCloud), zip files or password protected documents.

What to expect when you initiate your claim

 

Benefit Intake Process

Benefit Intake Process

What we need from you

What to expect from us

  • Benefit Intake Specialist will review information to ensure all needed documents have been received.
  • Claim will be assigned to Care Coordinator for evaluation

Benefit Eligibility Review

Benefit Eligibility Review

What we need from you

  • Details and timeline of claim for initial call with Care Coordinator

What to expect from us

  • Care Coordinator will contact you to review policy and timeline
  • Care Coordinator will order applicable records from physicians, care providers, etc.
  • Care Coordinator will review all available information to determine eligibility

Eligibility Outcome

Eligibility Outcome

  • If eligible, Care Coordinator will provide authorization letter and information on how to submit invoices
  • If not eligible, Care Coordinator will provide letter and appeal information
  • Notify Care Coordinator of any changes to providers or level of care

Claims Reimbursement

Claims Reimbursement

What we need from you

What to expect from us

  • Completed invoices will be processed, generally within 10 business days of receipt.

Legal Documentation

Examples of legal documentation may include: Power of Attorney, Executorship/Executrix papers, Last Will and Testament, Guardianship, Health Proxy, Living Trust.

Details

Details may include diagnosis, providers and dates of treatment, types of assistance needed, and who is providing assistance.

Changes in Providers, Care or Level of Care

Examples of change in care may include switching from one home care provider to another one, or hiring an additional provider.

Examples of change in level of care may include moving from a nursing home to hospice, nursing home to assisted living facility or vice versa.