If your loved one has purchased long-term care insurance in New York, it can help you manage and pay for their care needs. Maximizing your utilization of their policy can offset the costs of care and protect you from sudden charges.
However, long-term care (LTC) insurance can be tricky to use when it comes time to get care. Opening a claim and getting the most out of your policy takes patience, calm, attention to detail and precise communication during stressful and confusing conversations. It requires a deep understanding of both home care and insurance, and it takes a lot of time and energy.
Here’s the good news: a home care agency may be able to help. A good agency can make it easy for you to manage your loved one’s long-term care insurance claims, so you can maximize your utilization and minimize headaches.
How Does Private Long-Term Care Insurance Work?
Structurally, LTC insurance is, in some ways, similar to out-of-network health insurance. After getting your claim approved by the insurer, you can submit invoices and documentation to receive reimbursements for covered services.
But it’s not always easy to do so.
A Clarification for New York State Residents
Under New York State law, there’s another concept called managed long-term care (MLTC), which refers to Medicaid-funded home care services. Despite the similar name, MLTC is separate from private long-term care insurance.
Long-Term Care Insurance Can Be Difficult to Use
Like out-of-network health insurance, LTC insurance can be a major hassle.
Opening and managing a LTC insurance claim is a complex process, and can be difficult to get the full benefit of the policy unless you know what you’re doing. There are a few reasons for that.
- Insurers are cautious and slow-moving. Insurers are careful; they don’t make a decision without all the information in hand. That caution makes them slow, meaning it takes longer for them to respond to a claim and begin reimbursing you.
- Insurance assessments are difficult. When opening a claim, many insurers will send an agent to assess your loved one’s situation. When they get back to you, they’ll either approve or deny your claim. If you don’t speak the insurer’s language, it may be more difficult to get your claim approved than you expect.
- Submitting claims requires expertise and attention to detail. You’ll need to get activity and time sheets from your agency, open a claim and submit the activity sheets, time sheets and invoicing on a regular basis. Mistakes can cause your reimbursement to be delayed, reduced or denied. If claims are improperly denied, you’ll need to open a dispute.
FirstLight Home Care of Bronxville Can Manage Long-Term Care Insurance For You
LTC insurance is difficult to manage, and it’s hard to get help with the claims process. Home care agencies aren’t obligated to help you manage your loved one’s LTC insurance in any way—and many agencies in Westchester County don’t, or they charge to do so.
FirstLight Home Care of Bronxville is different. We understand that the burden of management can be a real barrier to your loved one’s care. We can remove that barrier by helping you manage claims and reimbursement, all as a complimentary service.
Here’s how we do it:
Claim Setup Help
The one thing we can’t do for you with LTC insurance is open a claim. Legally, the policyholder has to do that—but we can walk you through it and make it easy.
We coach you on how to explain your loved one’s needs to insurers in terms they’ll actually listen to. That means they’ll be less likely to push back or deny your claim—and if they do, we will coach you on the appeals process.
Getting your insurer on the same page from the start helps them open your claim more quickly so you can get reimbursed faster.
Claims Management
FirstLight Home Care of Bronxville can also handle the weekly LTC insurance claims submission and management process for you. With our deep knowledge of the insurance industry, we can keep your claims consistent and free of errors so you don’t have to worry.
Depending on your policy and preference, we can go even further via a process called assignment of benefits. This means that, once the claim is opened, you can appoint us to receive reimbursement directly from the insurer. That way, you don’t have to pay upfront or deal with reimbursements. The only bills you’ll receive are for services that aren’t covered.
Administrative Expertise
We know that dealing with insurers can be a full-time job, so we hired an expert to do that job right.
Meghan Fernandez, our Director of Operations, has made a career of home care administration. She studied the ins and outs of long-term care insurance in college, and she has over 10 years of direct experience engaging with insurers to manage claims and improve coverage utilization for clients.
Meghan knows how to work with insurance companies effectively. She’ll coach you on how to speak to the insurer when opening a claim to maximize your chances of approval. She has the know-how to handle pushback, expedite processes and submit your claims flawlessly. And she’s cultivated long-standing relationships with individuals at most insurers, so if something goes wrong, she can get someone on the phone to help.
To see how we can help you maximize your long-term care insurance usage to get the care your loved one deserves, contact us today.
