Claim Reimbursement

How do I get reimbursed?

Once that it has been determined that you are benefit eligible according to the terms of your policy/certificate, you are ready to submit invoices for processing.

Before contracting services with a provider, discuss this with your MetLife Care Coordinator. Your provider must be approved and verified as having licensure and credentials that meet your policy/certificate requirements. Failure to do so may lead to services not being reimbursed under your plan.

Waiting/Elimination Period

In order for reimbursement to occur, the required waiting/elimination period must be completed. In order to satisfy this requirement, the following needs to occur:

• Provider must be approved for reimbursement
• Invoices/UB04 need to be submitted to verify the days applied towards the waiting/elimination period

Please refer to your policy for details regarding your waiting/elimination period.

Invoice Submission

Your bills are proof of service or “claim.” Send them even if services have been paid by another insurance such as Medicare. We can often count those days towards your waiting/elimination period.

Your typed bill created by your provider needs to include:

• Your name and name of the provider on company letterhead.
• Dates and types of service provided.
• Fees charged per day or visit.

If filling out an independent or informal caregiver time sheet, the following information is required to be included:

• complete the monthly invoice form in its entirety
• copies of cancelled checks (refer to the independent or informal provider payment guides)
• one timesheet filled out completely for each caregiver separately as well as for each month separately
• signatures from the caregiver and insured or insured’s financial representative

For more information on invoice submission, select the appropriate guide to download based on the level of care you are receiving during your eligibility period.

• Provider Payment Guide & Invoice (Informal)
• Provider Payment Guide & Invoice (Independent)
• Provider Payment Guide (If your care is provided for via Home Care)
• Provider Payment Guide (If your care is provided by a Facility)