Long-Term Care Insurance Assessment

How LifeWorx Can Help

Managing long-term care insurance (LTCI) while ensuring your loved one is receiving quality in-home care is no small task. That’s why we’re here to help. From walking you through the initial steps to handling the back and forth with insurance companies, our LTCI team will stay on top of every detail to keep claims moving forward.

The LifeWorx LTCI administrator, Wiktoria Wolfson, provides the following services at no extra charge:

• Claim initiation
  She handles the entire approval process for clients. If a claim is denied, the appeal process is managed on the client’s behalf at no additional cost.
• Claim management
  Every two weeks, invoices and care notes are submitted to the insurance company to ensure reimbursement. Each submission is carefully tracked, including when and how it was sent. Care notes are also reviewed and kept up to date to show the client continues to need assistance with Activities of Daily Living (ADLs).
• Assessment coordination
  Whether the assessment is conducted by the insurance company or in-house, Wiktoria arranges and coordinates the nurse evaluations.
• Policy monitoring
  Annual updates are provided regarding policy details, including any increases due to inflation, remaining pool of funds, elimination period days, and more. Once services have started and the claim is approved, Wiktoria confirms the waiver of premium, so the client no longer pays premiums.

How We Help Clients File LTCI Claims

When onboarding a new client, the first step is an initial phone call to assess the client’s current needs and determine their stage in the process. If the client hasn’t initiated a claim, the administrator requests their claims packet and reviews the policy benefits with them.

Following the review, she schedules a call with the insurance company, giving the client the opportunity to hear directly from the provider and answer any questions they may have. During this call, Wiktoria helps the client explain why care is needed and guides them in making their case for claim activation.

To be approved, the client must demonstrate either:

• A diagnosed cognitive impairment
  or
• The need for hands-on assistance with at least two out of six activities of daily living

She also provides relevant details, such as the client’s provider, physicians, and hospitalizations. After the initiation call, the insurance company typically contracts a third-party nurse to conduct an in-home assessment to verify the level of need as described during the call. Based on the results, the insurance company will approve or deny the claim. The third-party assessment is the most important part of the claims process. To ensure the best outcome, Wiktoria guides the client on how to communicate their needs during the visit.

Many seniors, particularly those with Alzheimer’s or other forms of dementia, experience disorientation, wandering, or nighttime confusion, which can pose safety risks. With our live-in care, an experienced caregiver is always present to provide immediate support, whether that means guiding a client back to bed, preventing falls, or offering reassurance during moments of agitation.

Why the Assessment Matters for Insurance Approval

This assessment is critical in determining claim eligibility, as the insurance company uses it to confirm the client’s level of independence and the need for care. This evaluation is the final opportunity to document the policyholder’s care needs before the claims team reviews the files.

Unless the individual has a diagnosed cognitive impairment or has recently been hospitalized or undergone surgery due to an accident or fall, they will need to demonstrate the need for assistance with at least two out of six activities of daily living. This is what the nurse assesses during the visit, which takes place in the home. While telehealth assessments may occur, they are less common.

How it Works

Step 1: Find and understand your policy

The LTCI administrator begins by requesting the client’s policy packet. If the policy packet is not readily available, she will arrange a call with the insurance company, often including the client on the call. During this conversation, she will ask relevant questions regarding the policy benefits and will document the responses for clarity. If needed, Wiktoria will also request that the insurance company send the policy packet to the client to facilitate a comprehensive review of the coverage.

Step 2: Complete the care assessment

You’ll meet several fully vetted caregivers, each with a biography summarizing their skills and experience, activities they enjoy engaging in with clients, personality traits, quotes from their reference transcripts, and a photo from their in-person interview. From there, you can interview either in-person or over the phone or video call or simply decide based on their profile.  

Step 3: Receive care, get reimbursed

When the claim is finalized, the client works with the administrator to establish a start of care date, which is required to initiate the claim. From here, the client’s dedicated Client Relations Manager will work to find the best caregiver, and services will begin accordingly.

Clients then choose how they would like to receive reimbursement:

• The insurance company reimburses the client directly, or
• LifeWorx is reimbursed directly by the insurance provider

If the client opts for the second option, they will complete an Assignment of Benefits form, authorizing the insurer to send reimbursement checks to LifeWorx for the care provided. This form, along with a LifeWorx W-9, is submitted and shared with the client for their records.

If the client stays within their daily benefit amount, no additional payment is required. However, if the cost of care exceeds the daily benefit, or if the insurance policy doesn’t cover 100% of the bill, the client may be responsible for the difference.

To facilitate reimbursement, invoices and care notes are submitted to the insurance company every two weeks. Regular communication is maintained with the insurer, and all documentation is kept organized.

For clients with pools of funds, updates are provided annually to help them understand their available resources. Additionally, if the policy includes an inflation rider, any annual increases to the daily benefit are communicated so clients can adjust their care as needed.

These services are provided at no additional cost as part of working with LifeWorx.

Meet the LifeWorx LTCI Team

With years of experience managing long-term care insurance claims for our clients and an impressive track record of having never lost an appeal for services, our Long-Term Care Insurance team, helmed by Wiktoria Wolfson, is here to offer complimentary policy reviews and answer any questions you might have about your policy.

Our dedicated in-house long-term care insurance experts can help you:

• Understand your policy benefits
• Submit and track claims and appeals
• Manage invoices, payments, and reimbursements

Let us take the administrative aspects of long-term care insurance off your plate so you can stay focused on what matters most: your loved one’s care and quality of life.

Our Values

Trust

Our industry-leading vetting process ensures you never have to worry about who is coming into your home. Where other agencies may put restrictions on the level of communication you have with the caregivers, we trust that each person involved has the client’s best interests at heart and will always act accordingly.  

Superior Service

What sets LifeWorx apart is our dedication to a superior experience at every touch point. You won’t be shuffled between departments. When you call, your point of contact will handle your needs directly and collaborate internally to ensure an efficient and thorough solution.   

Relationships

We understand how tough it can be to juggle caregiving responsibilities while simply wanting to cherish time with your loved one. Our Client Managers work closely with families to ensure a smooth transition to trusted caregivers, handling the logistics and coordination with care and expertise. Meanwhile, our caregivers go beyond providing support—they build meaningful connections through thoughtful conversations, shared activities, and genuine companionship, bringing comfort and joy to your loved one’s daily life.  

Our Locations

New York

Chappaqua  Upper East Side  Upper West Side  Midtown Manhattan  Lower Manhattan  Brooklyn  Southampton  Great Neck 

New Jersey

Englewood 

Connecticut

Westport 

Florida

Sarasota  Venice  West Palm Beach 

Long-Term Care Insurance Providers

We work with all long-term care insurance companies in New York, Connecticut, New Jersey, and Florida. The most common are:

If you don’t see your insurance company listed here, please contact our LTCI Administrator to determine if we work with them.