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Improving the Long-Term Care Insurance Customer Experience

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What You Need to Know

  • Other types of financial services companies have portals.
  • Consumers can use apps to track pizza orders.
  • The author says similar tools could help LTC insurance claimants use their coverage.

Over the past decade, life insurers and financial services firms have begun investing in a variety of capabilities meant to improve their customers’ experience. These include mobile apps and self-service portals designed to help people manage their policies and assets.

Yet the long-term care (LTC) insurance industry has been slow to make the same investments for a variety of reasons. Many LTC insurers lack sophisticated electronic claims processing systems, which are needed to collect and house the data required to support online portals and self-service tools. Conventional wisdom also perpetuated the belief that older LTC insurance policyholders were not technologically savvy and would have neither the aptitude nor the equipment to utilize these new technologies.

But with the number of claims per active policies on the rise, and the constant drumbeat of rate increases being foisted on their LTC blocks, interactions between LTC insurers and policyholders are much more frequent today. Both rate increase and claims calls involve more complex interactions than those typical for a policy not on claim or impacted by a rate action. Given this changing dynamic, most major LTC insurers now have a strong desire to improve communications with their customers. This also ties into larger customer experience initiatives across their other product lines outside of LTC insurance.

New technologies certainly have the potential to streamline key processes involved in LTC insurance, including application processing, underwriting and claim payments. To enable this shift, many LTC insurers are turning to third-party administrators (TPAs) or specialized software vendors. Specifically, companies with electronic or web-based processing applications and technologically advanced claims systems are offering these capabilities to help insurers build out customer support tools, such as self-service applications.

At the same time, consumer interest in these resources is rising. Today, we can use digital apps to do everything from paying bills to tracking a pizza delivery. It stands to reason that consumers want to be able to do the same for every aspect of their lives, regardless of its complexity, including managing their LTC insurance policy.

While the average age of an LTC insurance claimant is 83, they are often supported by adult children who expect convenience and self-service options. Seniors are also more sophisticated than ever before, meaning many individuals are capable of accessing web-based portals via laptops, tablets and phones.

Streamlining the Claims Process

Certainly, complexity is the name of the game when it comes to LTC insurance claims. This process requires multiple steps and interactions between the insurer, provider(s) and policyholder — including requests for assessments, provider records, caregiver notes and clinical decisions — all of which can take several weeks to gather.

Consumers and caregivers have largely been on their own in this process. Few providers work with LTC insurers on behalf of the consumer, forcing claimants to submit paperwork and seek reimbursement after a charge has already been incurred.

The unique nature of LTC insurance also plays a role in this complexity. In some cases, decades may elapse between policy purchase and claims eligibility date. After all this time, individuals may not recall the details of their policy, and may need greater assistance in managing benefits once they go on claim due to their advanced age.

There are many ways for the customer experience to go right — and also terribly wrong — given how unfamiliar most people are with the overall LTC landscape and the complicated process insurers must go through to verify a legitimate claim.

Encouraging the Use of Policyholder and Applicant Portals

Yet these factors have given rise to a valuable opportunity to streamline the journey via new data-driven tools that provide information and guidance, including policyholder and applicant portals. These resources offer consumers visibility into the both the new business and claims process so they know where things stand and what needs to happen next. This includes whether information is still pending or a decision is in process, and when to expect a policy to be issued or a benefit check sent.

They also enable a policyholder to initiate a claim online rather than requiring a phone call to the insurer or their administrator during their regular business hours. Because of this, insurers can dedicate their call center staff to issues that require high-touch support and policyholders can file a claim when convenient for them.

Simplifying this experience benefits policyholders and insurers alike. According a recent satisfaction study of LTC insurance policies conducted by AHIP and LifePlans (now LTCG), policyholders who found it easy to file a claim were 17 times more likely to be satisfied with their policy overall.

Driving Providers Toward Electronic Billing and Data Collection

It’s not just consumers that want — and need — to go electronic. In order to improve the customer experience for all stakeholders, insurers must also engage care providers. This includes the use of claims clearinghouses that allow for electronic billing as well as the collection of digital provider demographic and pricing information.

These efforts can benefit the provider by streamlining cumbersome paperwork needed to verify provider eligibility and speeding turnaround times. Over time, this vast storage of electronic data will eventually allow insurers and TPAs to guide policyholders toward appropriate, affordable care based on their unique needs.

Ensuring Industry Sustainability

These examples are just the beginning of a transformation that has been overdue within the LTC insurance space. While many in the industry have previously resisted a move to digital interactions, the benefits for all stakeholders are clearly meaningful.

Creating a better experience for customers is not only the right thing to do, it’s also a business imperative that will ensure that LTC policyholders have the best possible support when needing critical care and accessing the policy that they rely on and have paid for over many years.


Peter Goldstein Peter Goldstein is the CEO of LTCG, a provider of administrative and clinical solutions for the LTCI industry.

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