Helen was terminally ill and consequently had to contract for round-the-clock caregiving services.  While she had long-term care insurance, she did not know the procedures necessary in order to initiate the payments.

When she queried her insurance company, she was told that they required certain documentation from her doctor to substantiate the need for her level of care.   Because Helen was neither physically nor mentally capable of dealing with her doctor, she had been unable to contact the doctor.

Instead, Helen contacted the agent who had sold her the policy.  Although it wasn’t the agent’s job, the agent volunteered to do the legwork to get the process going.  However, the agent did not have the time to follow up with both the insurance company and the doctor’s office to obtain the proper documents and authorizations.  Because of this, the process stalled for three months, during which time Helen was forced to pick up the cost of round-the-clock care from her own limited resources.

Learning of Helen’s plight, her HPWT service provider took charge of the process and, in only two weeks, was able to obtain the proper documentation and initiate the claim with Helen’s insurance company.  Not only did Helen start receiving her monthly long-term care payment of around $3,000 but also the HPWT service provider was able to arrange for retroactive payments of approximately $18,000.

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