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Long-Term Care Claims
To file a long-term care claim, please complete the appropriate claim form and follow the guidelines below:
- Complete Part 1 and sign the Authorization to Release Information (Form A-14282).
- Have the attending physician complete Part 2.
- Have director of nursing at the long-term care facility complete Part 3.
- Attach your bill from the long-term care facility showing the dates of admission and discharge, and the charges incurred.
- Include an authorization signed and dated by the patient with every claim.
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Aflac New York Toll-Free:
1-800-366-3436
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