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Always Best Care Case Study

About the Business

Ken and Robin Helfers opened Always Best Care® Senior Services of Louisville, Kentucky five years ago. They pursued opening a home care business after long careers in health care, human services, hospital management and insurance. Always Best Care of Louisville strives to be the best home care agency – not the biggest. The owners know their clients and caregivers personally, so they can create long-lasting matches. Mr. and Mrs. Helfers are both Certified Senior Advisors and Alzheimer’s/Dementia Trainers. As such, they provide a wealth of information to help seniors live as independently as possible, with maximum safety, comfort and dignity.

 

Challenge

Mr. Helfers handled third party billing in-house because he recognized the revenue opportunity long-term care insurance clients represented and he wanted to help them. But the overwhelming time and hassle to manage it all and the detrimental effect to cash flow were huge roadblocks to the agency’s success.

“Long-term insurance clients are very attractive because they have the means to pay for care. But the amount of time and effort to assist clients with processing their claims became overwhelming,” states Mr. Helfers. “As a courtesy, we provided the invoicing and care note services and submitted everything for the clients. But I could hardly do it once a month, which meant we were letting our clients down. We were forced to make clients pay us with a credit card so we would have a 30 day cash float, but the processing fees were expensive and it was still a hassle! When FHS called us, their timing was perfect because we wanted to process long-term care insurance for our clients, we just needed help.”

Mr. Helfers was dedicating his precious time to managing long-term care insurance policies instead of spending his time and effort on more pressing business matters.

“I ran out of time trying to manage it all and keep our customers happy with us. Whether or not clients understand how challenging long-term care insurance is to manage, all they notice is that it’s not getting done timely. You’re chasing down care notes and compiling all the information and then faxing it to the insurance company. We are a home care company, we are not an insurance processing company. It was taking me away from other things that are critical to the business,” explains Mr. Helfers.

Always Best Care of Louisville was in danger of losing clients to larger agencies that had the resources to hold a client’s Assignment of Benefit. An Assignment of Benefit (AOB) directs payment of policy benefits to a party other than the policyholder. “There was no way we could take the AOB because we just couldn’t handle that financially. There are bigger home care agencies in our town that take the AOB; that’s a competitive advantage they had over us. We were losing clients because we could not manage the process to the extent that our competitors could.”

Solution

Always Best Care of Louisville enjoys three main benefits as a result of partnering with FHS.

  • Outstanding Implementation and Support

“Getting started with FHS was easy. I had the usual concerns: How much time and effort will it take to adopt new processes? But the onboarding was painless. The speed with which we were able to get up and going and the support we received along the way were fantastic. Once you’re going with FHS, you realize how much of a no-brainer it really is!”

“The FHS team has been nothing but supportive. There was a client situation that did not even involve FHS, yet they helped me figure it out anyway and I was able to resolve it.”

  • Cash Flow Improvement

“Riding the peaks and valleys of cash flow is very stressful when you have not yet built up your business. We’re in a very competitive market, so it’s taken us a while to reach a comfortable level of clients. Managing cash flow is challenging without a billing partner like FHS because you must wait for thousands of dollars’ worth of invoices to come in so that you can meet obligations like payroll.”

“FHS has helped alleviate our cash crunch because they advance funds for clients with benefits. I used to hate sweating payroll, but thanks to FHS I can pay caregivers on time without any stress or worry.”

  • Complete End-to-End Solution for Long-Term Care Insurance Clients

“We used to lose clients to larger agencies because we could not take on the client’s Assignment of Benefit. That all changed once we partnered with FHS. We can now offer end-to-end support for clients with long-term care insurance.”

“In fact, we recently gained a new client who could not afford to pay a deposit yet she had a rich policy. We told her, ‘We just partnered with a great company that will take on your Assignment of Benefit and advance funds so we can pay your caregivers, which means there’s no out-of-pocket cost for you.’ Things lined up perfectly!”

FHS’ third party billing services have helped the agency and the clients and families they serve.

“Our long-term care insurance clients appreciate the great assistance they get from FHS because number one, there’s no cash out of their pocket; number two, they don’t have to process any claims or paperwork; and number three, they don’t have to rely on me to process it (which is good because I could not keep up with it!)”

Mr. Helfers’ clients also needed help understanding what their policy covers, so the Benefit Verification service from FHS has become invaluable.

“The people who are using the long-term care insurance policy are not the ones who are trying to administer or understand it. It’s the daughters of our clients who are trying to figure it all out. They don’t know when their parents bought the policy or what it covers.

FHS does a Benefit Verification in which they investigate the policy, call the insurance carrier, and decipher all the legal jargon. Their LTC experts put all the key points into a great report so that everyone involved knows crucial things like what services are approved for reimbursement and at what rate, what type of elimination period and/or inflation rider exists, and so forth.”

“I send the FHS Benefit Summary to the client and say, ‘This is exactly what the policy can do for your family.’ It helps families plan better because if the client needs 12 hours of care but the policy only covers 10 hours a day, they are prepared for that out of pocket expense. Our clients can now make informed decisions with this new knowledge.”

“The report also helps me understand what kind of client it will be because I know important aspects like the policy’s daily maximum and how many activities the caregiver must complete at each visit so that the family gets reimbursed.”

Result

Mr. Helfers appreciates the time and headache he saves by having FHS handle all the long-term care insurance billing.

“There were days that I said, ‘I’m going to get to the office early and finish all the claims and paperwork for our long-term care insurance clients. And by the end of the day, I was not even close to being done! The insurance companies make you bend over backwards to get claims approved. You have to get all the information organized and printed out, get it all faxed, and then hope the insurance carrier’s fax machine is picking it up. You have to re-fax things all the time. Plus there’s collecting the information, so I was chasing down pieces of paper constantly. It got to the point that it was taking me away from the business too much.”

Mr. Helfers considered hiring a full-time employee to manage the agency’s third party billing, but after weighing the costs and benefits he realized it was a smarter move to outsource billing to FHS.

“First you must ask yourself some key questions: ‘What is it going to cost to hire somebody? Can we afford to? Can I find the right person to do this? How much of my time and effort will it take to get this person up and running?’ Even if you do find someone, you will not be 100% confident that they’re going to do it right.”

“But with FHS, I have access to a whole team of long-term care insurance experts with decades of experience. Quite frankly, hiring a billing person also does not help you with the cash flow like FHS does. Getting the advanced funds right away is a vital part of the business. For all those reasons, outsourcing the billing to FHS was a smarter business decision.”

“I have had an excellent experience with FHS, so I would absolutely recommend them to other home care agencies. In fact, I already have! If you’re in any business, you’ve got to be working on the business not in the business. As a business owner, you always want to increase your efficiency and spend more time on the important business matters and less time on the administrative stuff.

The partnership with FHS has worked out so well for us and our clients. Things have lined up perfectly: FHS handles the insurance billing and takes the AOB and we provide the home care services. Our cash flow is better, the clients get the help they need with their policies, and I have more time to devote to growing the business.

You want to trust that your billing is going to be done correctly because it is crucial to your agency’s success.  It is so much better to enlist experts who are really good at long-term care insurance billing and know what they’re doing inside and out, and that is what we have with FHS.

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