Here’s The Trick to Making Long-Term Care Insurance Claims Easy

by | Sep 27, 2017

There are FIVE reasons that make long-term care insurance claims hard to file. Fortunately, there’s one trick which I have personally used to make the long-term care insurance claims process super easy. Here are the FIVE things that make it hard:

1. No prior experience

The hardest part about a long-term care insurance claim is that it’s brand new for everyone. Even though over one million people have received benefits from their long-term care policies, most of us have never filed a long-term care insurance claim. Your doctor has lots of experience filing medical insurance claims, but little or no experience filing long-term care insurance claims. Who do you turn to for help?

2. Medical Records

Before approving a claim the insurance company needs to review the policyholder’s medical records. To prevent medical records from getting into the wrong hands, privacy laws have created roadblocks which are designed to protect you. These same roadblocks, however, can cause delays in getting your medical records from your doctor’s office to the insurance company’s claims personnel.

3. Legal Documents

The policyholder is usually not the one submitting the claim. If a relative of the policyholder is submitting the claim the doctor’s office needs to know the relative has the legal authority to represent the policyholder. Until the doctor’s office is satisfied that you have legal authority to represent the policyholder, they can’t send any records to the insurance company. That’s why legal documents like a durable power of attorney should be in place well in advance.

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4. "Snail Mail"

Most communication with the insurance company has to be done via “snail mail” or over the phone. Sending health information via unsecure fax or email is a potential HIPAA violation subjecting the insurance company to huge fines. This can add to the frustration and delay the approval process even longer.

5. Potential Delay

Lastly, insurance laws in most states require the insurance company to either approve or deny the claim within 60 days from the date they received the claim form. If the medical records have not been received within that time, the claim has to be initially denied.

Here’s the Trick...

When my relative decided to file a claim on her long-term care policy in 2017 I did NOT handle her claim for her. Even though I’m a licensed insurance agent and I’ve specialized in long-term care insurance for over 20 years, I didn’t handle her claim.


We contacted one of the larger national home care agencies and they handled it for us. This particular home care agency processes THOUSANDS of long-term care insurance claims every year. All we had to do was sign a couple of HIPAA forms and they took care of the rest. Her claim was approved in only 3 weeks. 


They handled the claim for free. It makes sense.
The home care agencies get paid by the long-term care insurance companies.
They have a financial incentive to set up a system to speedily process long-term care insurance claims. 


When shopping for long-term care insurance it makes sense to work with an expert: a long-term care insurance specialist.


When filing a long-term care insurance claim it also makes sense to work with an expert: one of the larger national, home care agencies.

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