Long-Term Care Insurance Claims Resources

Free Long-Term Care Insurance Claims Processing - Find Quality Care

LTC News has teamed up with Amada Senior Care to process any LTC Insurance claim and offer complimentary care coordination at no cost or obligation to you. They can even assist in finding appropriate care for you or your loved one, no matter the setting or type of services required.

Amada Senior Care is a leading in-home healthcare agency with locations throughout the country. They can help you process a claim from any LTC Insurance policy. There is no cost or obligation for this service.

Amada Senior Care is also the preferred home care provider for LTC News readers and their families, offering additional services to help you and your family.

If you or your loved one need in-home care, Amada Senior Care provides the services you need, sometimes even at a discount (depending on location).

If Amada does not have a provider where you live, they will assist you in locating quality care options.

In our partnership with Amada Senior Care, we take advantage of Amada's existing relationships with the leading Long-Term Care Insurance providers and third-party administrators to simplify the claims process -- making the claims process easier for the entire family.

How It Works

These trained professionals can help you or your loved one understand the details of your LTC Insurance policy, and coordinate and deliver high-quality care.

The goal is to give you and your family peace of mind, knowing your or your loved one's needs are met. This can help everyone focus more on spending quality time together rather than on care needs.

Here are a few tasks these professionals can help out with:

• Review your LTC Insurance policy and explain your coverage.
• Help you make informed care decisions. (For example, using benefits for recovery or preserving the policy to allow aging in place.)
• Help you file a claim.
• Recommend and search for high-quality care facilities or home services based on your care needs.

The LTC News/Amada's LTC Concierge service is free for you. There is no obligation to use any provider.

We can assist with communicating directly with your insurance provider, activating benefits, and ensuring the policyholder receives the maximum monthly payout to cover long-term care expenses.

Get The Care You Need Now

Don't hesitate to use your valuable Long-Term Care Insurance benefits. You or your loved one has these benefits for a reason, and the sooner you file a claim, the sooner you or your loved one can get help.

Our partnership offers easy access to starting the Long-Term Care Insurance claims process.

If you don't own Long-Term Care Insurance but need help finding quality in-home care and developing a care plan for your loved one, Amada Senior Care can also help. All you need to do is fill out the form on Amada's home care resources page, and a trained professional will be in touch shortly to help you get the care you or your loved one needs.

To reiterate, helping process your Long-Term Care Insurance claim or finding the appropriate quality in-home care for you or your loved one is no-obligation and completely FREE of charge. 

How to Process a Long-Term Care Insurance Claim

Filing a Long-Term Care Insurance claim on your own can be complex, but understanding the necessary steps and working with a trusted professional can help ensure a smoother experience.

Below, we'll break down the steps of filing a Long-Term Care Insurance claim so you can better understand the process and requirements.

1. Locate the Long-Term Care Insurance Policy

Start by locating your or your loved one's Long-Term Care Insurance policy. 

If you or your loved one are unsure or unable to recall where the policy was purchased, try reviewing bank statements for premium payments or checking the mail for bills or letters from an insurance provider.

Once you've located the policy, you can begin to review your coverage and determine if it's comprehensive. 

2. Review the Policy Details

Most Long-Term Care Insurance policies are comprehensive, but not all. Here's a list of aspects to consider when reviewing your coverage:

• Benefit Amount and Duration: Determine the daily or monthly benefit limits and the maximum duration or total amount the policy will pay. Typically, there may be inflation benefits that have increased the available benefits. This information is crucial for planning in case the LTC policy benefit amount is less than the current cost of long-term care services. If you can't find the policy, you can request a copy. This 20 to 30-page contract spells out what is covered and for how much.
• Benefit Triggers: Identify the conditions that activate benefits, such as requiring assistance with a certain number of activities of daily living (ADLs) or cognitive impairment. If the policy meets federal guidelines, the benefit triggers should be very clear. Understanding these benefit triggers will help in assessing eligibility for claims.
• Elimination Period: Check if there's a waiting period during which you must pay for care out of pocket before benefits commence. Knowing the length of the elimination period is essential for budgeting purposes. Health insurance and Medicare will pay up to 100 days of skilled care, so, in some cases, the elimination period may be wiped out during this time.
• Covered Services and Providers: Verify which types of care (e.g., in-home care, adult day care, assisted living, memory care, nursing home) are covered under the policy. This ensures that the chosen care services will be covered.

3. Gather Necessary Documentation

Before initiating a claim, collect the following essential documents:

• Policyholder Statement: The policyholder statement provides the insurer with an overview of the situation. It is completed by the insured or their legal representative and details personal information and the nature of the claim.
• Healthcare Provider Statement: The healthcare provider statement confirms that the insured requires help with activities of daily living (ADLs) and/or needs supervision due to memory loss. A primary care physician or nurse completes this statement and outlines the conditions and need for either hands-on or stand-by assistance and/or supervision. Remember, a policyholder doesn't necessarily need to have a chronic illness since frailty due to aging can also lead to the need for long-term care services.
• Nursing Assessment and Plan of Care: An evaluation by a licensed nurse outlining the required care and services. This assessment helps in tailoring the care plan to the policyholder's needs. LTC News has arranged for Amada Senior Care to help with the evaluation and the required paperwork
• Plan of Care: Documentation from a case manager, healthcare professional, or care provider outlining the plan of care for the policyholder.
• Authorization to Release Information: A signed HIPAA medical release, also known as a HIPAA authorization or HIPAA consent form, permits a policyholder's protected health information (PHI) to be shared with the insurance company. This authorization facilitates the verification process.

4. Initiate the Claim

To initiate the claim, you must contact the insurance company's claims department to inform them of your intent to file a claim. 

You can find a list of contact information from several Long-Term Care Insurance providers below. Each insurance company will provide specific forms and detailed instructions based on their procedures. Some insurers offer online portals or mobile apps to streamline this process. 

5. Submit the Claim and Await Assessment

After completing and submitting all required forms and documentation, the insurance company will review the claim. This may involve:

• Medical Evaluation: An assessment to confirm that benefit triggers are met.
• Review of Care Plan: Evaluation of the proposed plan of care to ensure it aligns with policy provisions. This review verifies that the planned services are covered.

6. Monitor the Claim Status

Stay in regular contact with the insurance company to track the progress of your claim. The claim process can often take only three or four weeks, sometimes less. Promptly provide any additional information they may request to avoid delays. Maintaining open communication can expedite the process.

7. Begin Receiving Benefits

Once approved, benefits will be disbursed according to the policy terms. Often, the policyholder can assign the benefit to the provider, so the provider bills the insurance company, and the insurance company pays the provider directly. 

Some LTC Insurance policies will pay cash benefits directly to the insured without the need for invoices. Ensure you understand the payment structure, whether reimbursement-based or direct payment to providers, and any ongoing documentation requirements.

Additional Tips

• Maintain Detailed Records: Keep copies of all communications, forms, and receipts related to the claim. This documentation is vital for reference and in case of disputes.
• Seek Professional Assistance if Needed: Most LTC Insurance claims are paid with little problem; however, there are other situations in which you may have to appeal a claim. Using the help available through LTC News and Amada Senior Services makes this process much easier.

By following these steps and maintaining clear communication with your insurance provider, you can facilitate a more efficient and successful LTC Insurance claim process.

What Happens if the Claim Is Denied?

If your LTC Insurance claim is denied and expenses aren't reimbursed or paid for, the insurance company will provide a clear explanation for the denial, either by phone or in writing.

In most cases, claim denials occur because the policyholder submitted a claim for services or expenses not covered under their policy.

There are times when policyholders do not meet the benefit trigger. If you attempted to process the claim yourself and benefits were denied, seek help with the Long-Term Care Insurance claims process now.

The Long-Term Care Insurance industry is not focused on denying claims-insurers paid out a record $14.1 billion in 2024 alone. By carefully reviewing the policy's terms and following the claims process correctly, you can improve your chances of receiving payment, even if your claim is initially denied.

Direct Insurer Claims Departments

Below you will find the major insurance companies who offered Long-Term Care Insurance and their phone numbers.