Don't fight the insurance battle alone. We act as your dedicated Case Manager, handling the complex documentation, audits, and billing so you can just be family again.
Most families are surprised to learn that an LTCI policy doesn't just "pay the bill" automatically. It requires strict, monthly legal verification. Here is how the process actually works, and why exact documentation is critical.
A policy won't pay until a physician or RN certifies that the client cannot perform at least 2 of the 6 Activities of Daily Living (Bathing, Dressing, Toileting, Transferring, Continence, Eating) OR has a diagnosed Cognitive Impairment like Dementia.
Think of this as your "deductible" in days (often 0 to 100 days). Families must pay out-of-pocket for this period before the insurance kicks in. Crucial detail: These unpaid days must be strictly documented by a licensed agency, or they will not count toward finishing your elimination period.
Insurance companies compare daily caregiver notes to the official Plan of Care. If the plan says your loved one needs help bathing, but the caregiver's log for Tuesday just says "companionship," the carrier may deny paying for that day. One wrong word can deny a claim.
If you go with a standard franchise, they will often mail you an invoice and tell you 'Good luck with the insurance.' The cash flow gap and the anxiety of proving your loved one is "failing" every month is exhausting.
"I built the agency I wanted for my own sister. That means protecting our families from the bureaucratic nightmare of insurance paperwork."
- Ali Khwaja, Founder