Professional LTCi claim management solves a universal problem.
Long term care insurers promised premium care and plenty of money to pay for it
Policyholders and providers have a mutual interest in high-quality and well-compensated care. Families want skilled, compassionate caregivers who keep their loved ones safe and make sure their health needs are met. They should never have to worry about their insurer cutting corners, assigning less competent caregivers, or forcing them to pay exorbitant out-of-pocket costs. Meanwhile, providers need to pay fair wages to attract and retain the best caregivers.
Unfortunately, LTCi has become the most frequently denied, delayed, and under-reimbursed type of insurance in modern history.
Recent legal developments and industry disclosures have shown that insurers are breaking their promises and routinely shorting policyholders tens of thousands of dollars (often without them even knowing). When it comes time to seek long term care, policyholders, families are at their greatest time of need and are often overwhelmed. Insurers prey on that knowledge to cheat on their legal and ethical obligations.
The result is less care than needed, lower-skilled caregivers, high out-of-pocket costs, and poorer health outcomes.
The self-managed process is designed to underpay
Over the past 40 years, health insurers invested heavily in a standardized system. Their investment paved the way for primary care providers to professionally manage the claims process for the patients. The best providers deliver a touch-free process, all the way from pre-qualification to payment collection.
The likelihood that patients could self-manage that complex process and receive full and timely reimbursement is very low.
Yet that's exactly the position LTC insures put their policyholders in. They saw what health insurers did and went in the opposite direction, creating a grueling obstacle course full of hurdles, trap doors, and deception at every turn.
Their most valuable trick? Making sure people don't know what they don't know.
Disrupting the status quo
We put an end to the self-managed process and do all the heavy lifting so that no one else has to. The result is a system that feels much more like the health insurance claims process everyone is familiar with. In a similar fashion, we take care of every detail. That means unlocking maximum coverage without you needing to call your insurer or jump through hoops.
Our concierge services include (but are not limited to):
- Verifying coverage & pre-qualifying claims
- Comprehensive, easy-to-read reports with relevant coverage terms & limits
- In-house, experienced registered nurses who work with caregivers and primary/specialty providers to assemble the best supporting documentation
- Planning & Preparation for insurers' ADL assessments
- Submission of clean, complete, and compelling claims (leaving no issues open to interpretation by insurers)
- Resolution of disputes (delay & denial prevention)
- Billing, collecting, and reconciling payments
- Claim monitoring to ensure uninterrupted benefits
- Unlimited recertifications when care needs change or care setting changes
- Fees that are always aligned with your financial interests. The better you do; the better we do.
A benefit for policyholders and an ally for providers.
When we launched the Long Term Care Advocacy Experts (LTCAE) in 2018, our original mission was to serve policyholders and families. We knew that virtually no providers were offering a comparable claim management service. Some would assist with paperwork and collect payments, but none embraced the opportunity to manage the process from end to end.
We still serve every policyholder and family whose provider doesn't offer professional claim management.
However, over the years we started hearing a recurring theme from policyholders: "If my policy can pay out hundreds of thousands of dollars, why don't providers just do everything the way my doctor does? Why wouldn't they market that as a selling point? Everyone with a policy would check them out first."
We listened and we evolved.
We now offer our full suite of services as a turnkey business solution for providers. We act as an extension of your business and compliment your marketing and revenue goals. Providers get the opportunity to distinguish themselves far above the competition, increase satisfaction, and open several new referral channels to grow their businesses.
Whether we're serving policyholders whose providers don't offer our services, or if we're partnering with a provider who dreams of taking their business to the next level, two remain true:
When insurers play by the rules and pay the bills, policyholders receive safe, compassionate, and top-notch care without unbearable out-of-pocket costs.
In turn, providers get paid what they deserve and can focus on what they do best: serving clients & families.
Eric Michael Salter, JD
Founder & General Counsel
I'm a healthcare attorney and began my career as a senior regulatory consultant at Banner Health before entering private practice. My passion is protecting healthcare providers and the public from insurer over-reach and the failures of government regulators. I believe healthcare decisions belong in the hands of patients and their providers; not financial institutions. Unfortunately, when left to their own devices, insurers seize every opportunity to minimize care, improperly influence providers, and cheat everyone out of payment.
Over the years, no other type of insurance claims process has frustrated me more than that of long term care insurance (LTCi). The systematic abuse of families by the LTCi industry pales in comparison to any other type of insurance, with no other type of insurer stealing a greater percentage of the money owed to policyholders per claim. The companies designed a broken claims system on purpose, with the sole intention of making policyholders pay what their insurance legally covers. Worse yet, it all happens at the most inopportune time for everyone.
Formal legal action is a very effective tool against wrongful claims handling practices. However, it has many drawbacks:
- Legal action is reactive. It's always after the policyholder has made countless phone calls and sent letters. It's also after the policyholder has had to pay for care out of pocket. Legal action is all about recouping losses; not avoiding them.
- Good legal representation is expensive
- Lawsuits typically take many years, during which the policyholder is still paying out of pocket and losing a fortune
- Attorneys are not healthcare providers and don't speak their language
- Legal action does not fit the care continuum. Care needs and LTCi claims occur continuously over many years and must be approved each time. Because legal action relates to a single dispute, it's almost always far beyond the curve and places policyholders at a disadvantage.
I wanted a system that would give policyholders and providers a strategic advantage before insurers could treat them unfairly. Using the courts to fight your way out of a delay or denial will work, but it's better to prevent the need to fight in the first place.
Fortunately, lawsuits and investigations over the past 10 years have pulled back the curtain on insurers' tricks and made many of them avoidable, but that knowledge is not very accessible or even necessarily useful to the general public. I took advantage of those legal developments and created LTCAE in 2018 as a total claims management service for policyholders and providers.
We have registered nurses and medical billers who speak the language of providers and work with policyholders to get each claim swiftly approved, while avoiding having to resort to legal action. If a payment is disputed, we appeal and resolve issues at the administrative level to prevent legal conflict. There's no substitute to going out and hiring a lawyer after you've lost everything, but our mission is to let policyholders get out in front of the problem and prevent themselves from being treated unfairly in the first place.
The result is a hands-free, streamlined service at a fraction of the cost of legal war. And that's also without families going into debt, waiting countless hours on the phone, sending letters, chasing documents, and spending the final years of their loved ones' lives fighting an insurance company.
Professional claims management isn't about raking insurance companies over the coals. The insurers dictated the terms of the policy contracts when they created them. It's merely about giving policyholders and providers the hassle-free ability to make them keep their promises.
When people can take control and get paid in full, that's peace of mind.