Financial Advocacy: Cutting through the Red Tape of Long-term Care Insurance

Many home care agencies strive to meet their clients’ total needs. But all too often the financial aspect of care is overlooked. Since most clients cannot afford to pay for all of their care out of pocket, many turn to third party sources such as long-term care (LTC) insurance. But for a family struggling with the payment process, identifying that their loved one has an LTC insurance policy is only the beginning.

The Nightmare of LTC Insurance Billing

Billing long-term care insurance is confusing, complex and time-consuming:

  • State insurance commissioners across the country receive more than 5,000 complaints every year of payment refusals by LTC insurance companies.
  • Approximately 25 percent of all LTC insurance claims are left unpaid because carriers insist policyholders be so impaired that almost no one qualifies.
  • An article from CBS News likens billing long-term care insurance to “. . . death by a thousand cuts” since you must fax hundreds of pages of required documentation.
  • According to The Wall Street Journal, “even those with severe disabilities, including Alzheimer’s patients, may have trouble filing claims.”

What is Financial Advocacy?

It’s inconceivable to expect family members who are already overwhelmed by a stressful, emotionally-draining situation to take on the enormous challenge of battling their insurance carrier. That’s why FHS SeniorCare Payment Solutions® steps in to assist.

  • Educating Seniors and their Families

FHS interprets the jargon in a client’s LTC insurance policy and turns it into something they can understand. The Benefit Analysis we provide includes all the important points, such as:

  • what the policy covers (adult day care, home care, hospice),
  • the daily benefit maximum (which can vary by the type of care),
  • the total policy maximum (will the policy be capped at a certain dollar amount or not),
  • how long the elimination period is if one exists,
  • if there’s an inflation rider and if so, how much,
  • if the home care agency needs a certain type of license, etc.

Many seniors do not remember what they bought 30 years ago! The Benefit Analysis helps them determine how much, and what type of care, they can afford to receive.

  • Ongoing Claims Submission & Advocacy

After FHS verifies a client’s benefits, we shoulder all of the ongoing paperwork submission and follow up with their carrier for the inevitable denials, delays and appeals. Many policies require that a client’s caregivers submit proof that they assisted clients with a certain number of Activities of Daily Living during each visit. Collecting, properly formatting and submitting claims on a weekly basis takes time—time that family members typically do not have.

What is YOUR Agency Doing to Help Clients with LTC Insurance?

Key questions agencies should ask themselves include:

  • What are we doing to help clients and families navigate funding and LTC insurance claims?
  • Who in the client’s family will manage third party billing, and do they realistically have the time and expertise to handle it?
  • Do my competitors offer assistance with third party benefits?