Long-Term Care Insurance (LTCI) Claims Advocacy

Saving you time, minimizing your anxiety, and guiding you towards a successful outcome.

We advocate for you by becoming your point person

If you need medical care, your house is damaged or you’re involved in an auto accident, who files the claim? The insurance company. If someone needs long-term care is the same true? No, it’s not! You’re on your own and, likely, you’re not the policyholder. Daughters, family members, or good friends often spend days or weeks trying to make sense of whether an insurance benefit exists and how to take advantage of its benefits.  Having professional LTCI advocates who are knowledgeable about the process and can do it efficiently and accurately saves time, money, and lowers stress.  

villageplan’s™ long-term care specialists are here for you! We are committed to spending the time following up with medical records, sending emails and faxes, and organizing a claim packet. We work with home care agencies, attorneys, financial advisors, assisted living communities, physician offices, hospitals, and other professionals.

father and son walk together with coffee in hand.

The Value of Having a Long-Term Care Claims Advocate

Premiums have been paid for years, probably decades and it’s time to secure the funding to pay for the expensive costs of long-term care. Your loved one must have someone accurately representing that person’s impairment to increase the chance of an approved claim of long-term care. Villageplan™ continues to be that valuable representative. 

We advocate during the claim and as we do so, we are assessing the three main parts. They serve as the foundation for the policyholder’s needs and it’s what Villageplan™ utilizes throughout the process.

Many healthcare providers don’t document all the long-term care needs or describe them the way they are defined in the LTCI policy. A claims advocate’s watchful eye spots this before the plan of long-term care is submitted and it is corrected for accuracy.

Policyholders’ medical records may not have current or complete information about their health conditions. When insurance companies request and review them, they often call policyholders for clarification. Elderly people are often hesitant to disclose private self-care areas like toileting and incontinence. Infrequent check-ups at the doctor’s office create more problems for long-term care. A claims advocate works with the doctor’s office to obtain all the information needed to show the true level of frailty. 

Many companies will hire an independent agency to make sure the home care agency and/or the assisted living/skilled nursing facility’s first assessment is accurate. To preserve their dignity, many policyholders will say they don’t need someone to help when they really do. A claims advocate attends this interview and arrives early, informing the policyholder to swallow their pride for only a while and accurately depict what it's like on their worst day.

LTCI advocacy FAQs

Having a long-term care benefits insurance policy doesn’t mandate an automatic approval of a claim. There’s more to a claim packet than just an application. Also, it takes patience, know-how, excellent time management, and organizational skills to create a successful outcome.

Because cognitive impairment needs to be significant enough that policyholders need supervision due to safety concerns for themselves and others. Also, there should be an assessment of their cognition that the person consents to and if there’s any denial present, that’s a problem. Villageplan™ interprets policy language, knows what to look for, and offers families strategies to deal with denial and anxiety before an assessment.

We are open to understanding why the claim was denied and if there’s a chance it could be overturned, yes we can help design a formal appeal.

We’re still here to help! Villageplan™ monitors the waiting period, follows up on reimbursements, and ensures that premiums are waived while on a claim if that’s part of the policy. 

Free Download: 8 Steps to Filing an LTCI Claim

Why Choose villageplan™?

We have over 30 years of experience working with clients and their insurance companies. We know how to make this process smooth and successful. We also have Mental Health Counselors, Professional Care Managers, and Home Care providers waiting to provide additional services that benefit many families who need help with long-term care coverage. We also want you to have a choice. If you need our help partially or would like to outsource the entire claim process, we are available in whatever capacity you need us. 

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