Success Tips For Long-Term Care Claims – Part Two


by Tim Colling~In Part One of this series, we offered a list, shown below, of tips about how to prepare and file claims for benefits under Long-Term Care Insurance (“LTCI”), promising to provide more detail. In this installment, we’ll cover the first three of them.

  1. Choose one person to be in charge of filing the claim.
  2. Be very organized, prompt and businesslike and get the claim filed right away.
  3. Get help in filing the claim from someone who knows what they’re doing.
  4. Make sure the claim is complete when you submit it, including all forms and required supporting documents.
  5. Plan ahead to pay out of pocket until the insurance company approves the claim.
  6. After you have submitted your claim, follow up at least weekly and keep notes.

Choose One Person Who Is Going To Be In Charge Of Filing The Claim

In situations where there are multiple family members or friends involved, it’s a good idea to select one person to be the “project manager” in charge of filing the claim. The project manager should be the one who:

  • Acts as the sole person from the family who interacts with the major players in the process, such as the Long-Term Care Insurance company, the doctor who will attest to the need for care, the care provider organization, and others.
  • Completes the documents required for the claim, or delegates the completion of them to others and then follows up to ensure that they are completed.
  • Follows up with the Long-Term Care Insurance company on a regular basis to check on the status of the claim and to prevent unnecessary delays in processing the claim.

Be Very Organized, Prompt And Businesslike And Get The Claim Filed Right Away

Long-Term Care Insurance claims can sometimes be complicated, almost always requiring multiple documents from multiple sources. It is very helpful to organize the claim preparation and filing process like you would do with any project, with a checklist of things that must be done, and when you expect to have them done, and with notes to refer to later if needed.

It’s very important to get the claim filed as soon as possible, but only after it is as complete as possible. The sooner it’s completed and filed, the sooner it will be that the benefits payments will begin arriving.

After the claim is filed, you should call the LTCI company at least once a week to make sure that they are processing the claim in a manner that is prompt, fair and correct. Keep written notes about each call, including the name and identifying number or extension of the persons you speak to, the date and time of each call, and a record of what was discussed and promised by both you and the LTCI company representative.

Ask Your Care Provider Organization To Help With The Entire Process

While you may only file one or two LTCI claims during your lifetime, your care provider, whether it’s an In-Home Care Agency or a Skilled Nursing Facility, has probably worked with many families who have LTCI claims and ongoing reimbursements. Because of that, provider organizations have a fair amount of experience and expertise with respect to getting LTCI claims filed and perfected.

Each care provider organization makes its own policies and procedures for assisting with LTCI claims. Some providers may charge a fee for filling out that form or helping with some or all of the other forms necessary for their clients’ LTCI claims. You’ll need to ask your care provider organization about their policies and fees in this regard.

At a minimum, though, your care provider organization should be willing to complete the form that the insurance company will require that makes it possible for the insurance company to approve that organization as a “provider” under the terms of the LTCI policy. The LTCI company will only pay benefits under the policy if the insured person is receiving services from a “provider” that the insurance company has approved.

Care Provider Organization Approval Considerations

Sometimes LTCI companies will try to withhold approval for care providers in order to delay claims payments. However, most experienced care provider organizations will know how to address, and overcome, those objections from LTCI companies.


Have one person be the claims project manager, and enlist the help of the care provider organization that is involved with the insured person. Then, be prompt and organized, keep good records, and follow up weekly to make sure that the LTCI company is getting its work done in a way that is timely and correct.

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About Tim Colling

Tim Colling has more than 30 years of experience in management in a variety of industries and has served in the past as a member of the statewide steering committee for the Home Care Aide Section of the California Association for Health Services At Home (“CAHSAH”). He is a Certified Public Accountant (licensed but not actively in practice), and received his Bachelor’s Degree in Accounting from California State University at San Diego. He has held the credential Care Manager Certified ("CMC") from the National Academy of Certified Care Managers, and has practiced actively as a Professional Geriatric Care Manager. Tim has worked as a CPA in Public Accounting, a corporate Chief Financial Officer for a chemical manufacturing company, and a software engineering manager for several private and public software companies, in addition to working as an eldercare manager, in-home caregiver agency administrator and professional geriatric care manager since 2003. Learn more about his in-home caregiving company at A Servant's Heart In-Home Care

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