Claim Management vs. Claim Filing Specialists

LTCAE Claim Management vs. Claim Filing Specialists

The rising obstacles to Long Term Care insurance reimbursement have given way to a garden industry of so-called “claim filing specialists.” What are they?

Claim filing specialists are current or former insurance sales agents, along with low-paid administrative call center staff who assist policyholders in gathering documentation and submitting claims. The agents are still on the corporate insurance payroll and “up-selling” a claim assistance program. Even if the agent is no longer actively selling insurance, they are typically still receiving commissions from the policies they sold in the past.

A sales agent knows more about filing a claim than the average policyholder and can offer to help you organize and submit your documents for free. In fact, doing so can be admirable. When they charge to service a policy you bought from them, they’re double-dipping.

Despite the obvious ethical considerations, such insider dealing is not illegal because the LTC insurance industry is so poorly under-regulated. Nonetheless, paying a sales agent to file your claim adds needless expense and could result in you missing out on tens of thousands of dollars in reimbursement or result in you getting less care than you’re qualified for.

Why? After all, sales agents are certainly not the enemy. They serve a valuable purpose by teaching consumers about the importance of buying LTC insurance. Without agents, everyone who doesn’t qualify for government assistance would be stuck paying for care out-of-pocket.

Simple. Sales agents are not health care or legal professionals. LTC insurance sales agents complete an 8-hour class and a short exam; not a 4-year nursing degree and hands-on patient care experience. They have no training or professional frame of reference from which to understand diagnostics and help you identify and select the best hands-on care options.

A sales agent is also not a healthcare and regulation attorney with a deep understanding of the complexities involved in medical billing and insurance coverage disputes. LTC insurers are notorious for denying and disputing claims, but the ability of a sales agent to navigate the legal minefield is extremely minimal at best. When an policyholder invariably runs into obstacles, they can end up stuck between a rock and a hard place (with a deep hole in their pockets).

Whether you’re considering filing a claim or you’ve already filed one and are running into headaches, we always encourage policyholders to consider what’s at stake. After all, claims are often worth hundreds of thousands of dollars from start to finish. Don’t go it alone and sell yourself short.

Give yourself the gift of peace of mind and make sure you’re getting the benefits you deserve. We’ll work hard to get them for you – in full and on time.

Remember: If long term care insurers treated policyholders and providers fairly, we wouldn’t be in business.

Schedule your free consultation today and discover how much you have to gain with LTCAE.

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