How to track long-term care insurance invoices and reimbursements

Once a long-term care insurance claim is underway, one of the most confusing parts can be keeping track of the money.

An invoice arrives. You pay the provider. You send the invoice to the insurer. A reimbursement arrives some time later — and by then, another invoice has arrived before you have finished matching up the first one. After a few months, it can be hard to remember which payment belongs to which invoice.

If your policy reimburses some or all covered expenses, a simple tracking routine makes this much easier.

Treat the invoice and the reimbursement as two records

It is tempting to treat them as one transaction. In practice they happen at different times, so record them separately.

For each invoice, record:

• the provider
• the invoice number
• the service period
• the date you received it
• the amount billed
• the amount you paid, and when

Then, separately, record what happens with the insurer:

• the date you submitted it, and how
• any submission or reference number
• the reimbursement date and amount
• the payment or statement reference
• any difference that has not been explained

That lets you answer two separate questions: what did the provider bill, and what did the insurer reimburse? The numbers are not always the same, and your records should not assume they will be.

Keep the original invoice

Your insurer may require itemized invoices or other documentation, depending on the policy and the type of care. The Federal Long Term Care Insurance Program, for example, asks for individual dates of service, hours and charges per day, and a description of the services provided. Keep the original invoice or a clear electronic copy.

If a provider sends a revised invoice, keep both, and note which is which, rather than silently replacing the old one. If someone later refers to "the September invoice," you will know exactly which document they mean.

Record each submission

Submission dates matter because they let you reconstruct the timeline. For each submission, note what you sent, when, where and how you sent it, and any confirmation or reference number you were given.

Follow the insurer's instructions on how to submit, and avoid sending the same document more than once unless they ask you to. Some insurers, including the Federal Long Term Care Insurance Program, warn that duplicate submissions of the same invoice delay processing. If you are not sure something arrived, ask the insurer how to check before sending it again.

Match each reimbursement to what you submitted

When a payment arrives, write down more than the amount. For example:

• Received: $1,840
• Date: October 12
• Appears to relate to: the September invoice from the home care agency
• Payment reference: 12345
• Status: matched

If you cannot tell which invoice a payment relates to, mark it as something to ask about rather than guessing. Your records are there to help you ask a precise question: I received this payment — which submitted expenses does it cover?

Note differences without deciding what they mean

Suppose an invoice was $3,000 and the reimbursement was $2,400. Your record can show a $600 difference. It should not try to explain it.

There can be many reasons for a difference, and the answer depends on the policy and the claim. Record the numbers and, if you need to, add a follow-up: Ask the insurer about the difference between the September invoice and the reimbursement. That keeps your recordkeeping separate from interpreting the policy.

Watch for items that have stopped moving

Often the most useful part of a reimbursement record is not what has been paid. It is what has not. A regular review might turn up:

• an invoice received but not yet submitted
• a submitted invoice with no response yet
• a reimbursement that has not been matched to an invoice
• a provider balance still open
• an additional document the insurer asked for
• a question about a reimbursement still waiting for an answer

Those are things you can act on. A long list of completed transactions matters much less than knowing which three items still need attention.

Keep calls and letters connected to the money

If you call about an invoice, make a short note of the call. If the insurer asks for another document, record the request. If a provider sends a corrected invoice, note that too.

You do not need one giant table. You need enough cross-reference — an invoice number in a call note, a date beside a request — to follow the sequence later. Call notes, follow-ups and document copies are covered in more detail in organizing a long-term care insurance claim.

Build a monthly routine

For a claim that continues over months, a simple routine keeps the record current without much effort:

1. Gather invoices, receipts, payment statements and insurer letters.
2. Record new invoices and reimbursements.
3. Submit whatever documentation the insurer currently requires.
4. Match payments you received to the invoices they relate to.
5. Follow up on anything missing, unclear or still waiting.

Once it is routine, it takes much less mental energy.

Policies pay in different ways

Long-term care insurance policies do not all pay benefits the same way. Some reimburse what you actually spend, up to a limit. Others pay a set amount regardless of the actual cost, and some pay the benefit whether or not services were received. Requirements can also differ by policy, insurer and type of provider.

Use your policy and the insurer's instructions to know what documentation your claim actually needs. The organizing idea works either way: keep enough information to follow each care expense through to submission and payment.

You do not need perfect accounting

This is not an insurance company's ledger. For a family managing a claim, the useful questions are simpler:

• What have we been billed?
• What have we paid?
• What have we submitted?
• What reimbursements have arrived?
• What still needs attention?

If your records answer those quickly, they are doing their job.

Sources and further reading

• Claims Reimbursement — Federal Long Term Care Insurance Program
• Invoice Submission and Reimbursement Package — Federal Long Term Care Insurance Program (PDF)
• Long-term care claim payments — Genworth, one insurer's process
• A Shopper's Guide to Long-Term Care Insurance — NAIC (PDF)