Why LTC Insurance Works Better With an Agency
When your loved one needs care, the last thing you want to do is work through insurance paperwork, confusing claim requirements, or delayed reimbursements. Many families turn to independent caregivers thinking it’ll be simpler or less expensive than working with a home care agency. What they don’t always realize is that claims can take weeks or months to process, and even one missing form or documentation error can cause delays or denials.
At LifeWorx, our job isn’t just to send a great caregiver to your home. We’re your partner throughout the entire long-term care process. Our dedicated long-term care insurance administrator, Wiktoria Wolfson, will oversee your claim from start to finish. She communicates directly with the insurer, manages all documentation, and ensures your claim progresses without delays. This approach allows families to focus on spending quality time with their loved ones, knowing that the paperwork is being taken care of.
Streamlining Long-Term Care Insurance Claims
Insurance companies can be very particular, and policies are often filled with dense language and strict requirements. With over 8 years of experience, our long-term care insurance administrator knows what insurance companies need to see and how they want it presented to help move claims forward with ease.
LifeWorx prepares and submits:
- Plans of care
- Care notes highlighting the need for assistance with Activities of Daily Living (ADLs)
- Itemized invoices
While independent caregivers are dedicated and skilled at providing hands-on assistance, they typically don’t offer administrative support. This leaves families managing their ongoing claims, which can complicate the insurance process and delay reimbursement.
If your claim is denied, and many are, we don’t leave you to figure it out. Our LTCI team will draft and file the appeal, rectify any issues, and resubmit all documentation.
Agencies Provide Licensed, Credentialed Caregivers
Many people don’t realize that most long-term care insurance policies require care to be provided through a licensed agency. While most home care agencies are properly licensed, many private caregivers operate independently and may not have the necessary credentials, such as a Home Health Aide (HHA) certification. Families often don’t think to ask about these qualifications before hiring, which can lead to denied insurance claims and stress. Our agency eliminates this risk by providing licensed caregivers and maintaining a deep bench of qualified backup caregivers.
Case Study – The Cost of Handling Claims Alone
We recently worked with a client who is insured through John Hancock. Her husband requires daily assistance for cognitive and physical challenges. Our LTCI administrator walked her through what she could expect, preparing her for the insurer’s home visit. The administrator explained what she needed to highlight during the assessment to provide a complete picture of her husband’s needs. This is important because it’s common for clients to downplay how much support they truly require. While understandable, this can unintentionally result in denied or delayed claims. With our guidance, we help families communicate their realities clearly and accurately to ensure their loved ones receive the coverage they deserve.
Before working with LifeWorx, the couple had been using independent caregivers. Unfortunately, they didn’t realize that John Hancock wouldn’t count the caregiver’s assistance toward the elimination period because they didn’t have the proper documentation or proof of licensing. This meant months of care didn’t apply toward reimbursement, leading to significant out-of-pocket expenses.
Once we stepped in, the claim moved forward because she was able to demonstrate proof of care by providing itemized invoices that included a start of care date. She was relieved to learn that with our support and record keeping, her application met the necessary criteria. This professional handling of claims provides families with a sense of security and confidence.
Streamlined Documentation & Claim Support
Long-term care insurance providers require accurate, ongoing documentation to justify payments. Working with a home care agency like LifeWorx means gaining access to a team that handles all the logistics. We provide:
- Electronic documentation of care – We track care provided weekly, including Activities of Daily Living (ADLs) through care notes
- Claim submission – Centralized record-keeping of insurance documents such as HIPAA forms, claim initiation packets, and more
- Dedicated care coordinators – Our experienced administrator speaks directly with insurance companies on behalf of the client, ensuring smooth communication
- Detailed record keeping – We keep detailed files, so if clients ever need to confirm when forms were submitted, we have that information available
With an independent provider, families are often left responsible for maintaining these records themselves, which can lead to delays in reimbursement if there are minor mistakes or missing forms.
When working with LifeWorx, we handle all documentation and pay the caregiver on a weekly basis, so our clients don’t have to. We also offer an Assignment of Benefits (AOB), which allows the long-term care insurance provider to pay us directly. As long as services remain within the daily benefit limit, there’s typically no out-of-pocket cost to you.
If care costs exceed the daily benefit, we’ll first receive reimbursement from your LTCI provider. After that, we’ll invoice you only for the portion that’s not covered. This process saves families time, money, and unnecessary stress.
Continuity of Care
If an independent caregiver becomes ill or unavailable, care may be interrupted. Families working with independent caregivers may struggle to find short-notice coverage. If care stops, even for just a few months, claim eligibility and payments may be affected.
LifeWorx, on the other hand, provides:
- Caregiver replacements on short notice
- Holiday and emergency staffing solutions
- Continuity of care plans that align with insurance requirements and the ADLs provided in the original claim
Whether you need coverage for a single shift or a sudden change of schedule, we have the resources and team to keep your loved one’s care running smoothly.
We’ve designed our services to provide both compassionate care and peace of mind. Contact LifeWorx today to speak with a care coordinator and get started. Our LTCI team is available to review your policy and answer your questions.
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