When the time comes, either you – or one of your adult children – will need to open your policy to receive reimbursement. Make sure you have kept track of your paperwork, policy numbers, and managed your POA accordingly. The first step is to reach out to the provider and initiate a claim – at this point, if your benefit is approved, your elimination period starts. This is important, because it takes 2+ weeks to open a policy. Doing this ahead of time can help you realize savings.
Your provider will send out an RN to do an evaluation, where they’ll assess your parent’s needs. This is typically oriented around the activities of daily living: bathing, toileting, dressing, transfers, eating, and fall risk prevention. Most policies require help with 2 or 3 of the activities. If your loved one has a cognitive impairment, make sure to have a physician's note, as this can be harder to identify during a nursing assessment. Often, older adults tend to under communicate their needs. It can be helpful to be present during the assessment to ensure you’re communicating your parent’s needs and giving the RN the best understanding possible.
After the RN completes his or her visit, the company will review the assessment and measure it against your policy terms. This typically takes 5 to 10 days. Make sure you’re taking the initiative to follow up with the insurance company. Don’t wait for them to come to you.