Claims Assistance & Advocacy

Claims on Long-Term Care insurance policies are usually filed decades after the policy was purchased as the insured ages. With the passage of time, people tend to forget the details of their policy and some even forget that they have the policy. For this and other reasons, proactive representation by your broker is critical at claim time.

American Medicare Counselors has specialized in collecting benefits on Long-Term Care insurance policies for the past 30 years. Over the years we have collected maximum benefits for hundreds of clients. Our goal is always to identify and collect all monies that are due to our clients from their long-term care insurance. We know the details and fine points of Long-Term Care insurance and we know how to collect all benefits to which our clients are entitled. We aggressively pursue full claim payments through to a satisfactory resolution.

Our services are user-friendly. We strive to make the claims process as simple and stress free as possible. Our clients, or their representatives, send us all relevant paperwork, including care giver bills and outstanding and disputed insurance claims. We file LTC claims and follow them through to resolution. We track existing claims and payments, and file and follow-up on any outstanding claim discrepancies.

Our service includes verifying policy terms regarding insurance coverage.

We determine which bills are not reimbursable (that is, would not be covered under the policy in place.)

We review the entire situation and file claims for ancillary costs, such as for medical goods and services, which should be reimbursed by private insurance, such as Medicare Supplement policies and provider’s excess charges.

We evaluate rejections of claims and resolve disputed rejections.

We identify and resubmit improperly denied claims.

We verify receipt of refunds due to the insured from insurance companies.

We secure payment from providers who have been overpaid.

We tell you when to pay invoices from providers.

We represent you, not the insurance company.

And, our services are free for our group and individual LTC clients.

Example of how we help:

Problem – Unknown Policies

Family, friends and caregivers do not always know about the details or even existence of an older adult’s insurance policies, especially Long-Term Care insurance policies. The result can be that valid claims are never filed. We can help and have even collected on LTC policies for estates after the insured had passed away.

As an example, an elderly Medicare beneficiary passed away after a six-month illness which had kept her at home receiving informal care from her family and friends. She had a Long-Term Care Insurance policy that paid benefits for informal care, but no claim was ever filed. No one knew that the policy existed, not the family, the lawyers, or the caregivers.

Our Solution: We reviewed the Long-Term Care Insurance policy and saw that the insured would have qualified for benefits if a claim had been filed. We filed a claim for the six months she would have qualified for benefits and proved that the Long-Term Care Insurance policy would have paid benefits to cover the last six-month period if a valid claim had been filed. We also proved that the insured suffered from a cognitive impairment that made it impossible for her to understand her insurance policy or even know that she had it. We were able to reconstruct a valid claim, which the company honored. The estate received $27,300 ($150 per day for 182 days).

Our service includes verifying policy terms regarding insurance coverage.


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