Often our clients have a long term care policy with which they expect to pay home care help using payroll services. While this may sound simple – you pay the home care worker and the insurance pays you – in practice, there are a few extra complexities in getting the policy to approve the care and getting reimbursed from your policy.

First, the claim has to be approved. There are two “hurdles” to clear in the contract: (1) the policy holder has to be medically eligible for care and (2) the care giver has to eligible according to the contract. This last is particularly the area where we can be a resource.
Some policies will pay home care givers who are not licensed (also known as “informal caregivers” in insurance language), some will only pay a licensed care giver, and some will only pay a care giver from a licensed agency. So, before you hire, you will want to know what type of care givers are allowed under the home care provision of the policy. Insurance companies will follow that contract to the letter – the “devil is in the details” here.

If you are certain you have the right type of care giver selected, then you have to make sure you have appropriate documentation of the care. Insurance companies are tasked to do due diligence and avoid fraud at all costs. So on most contracts1 you have to submit to the insurance company (at regular intervals) detailed invoices, daily visitation notes documenting care, and proof of payment. The process of claiming on long term care is a little more document intensive than merely paying payroll.

This is where our staff and expertise can be of value to you. We have resources available to read the contract and determine if any particular care provider will qualify according to the contract -- in advance of hiring. We are also able to help create and manage the other documents that must go to the insurance company so benefits will pay.

If you – or someone you know – is facing a claim for home care services, getting answers on this early helps avoid problems down the way.

Most polices are reimbursement policies, meaning you pay the home care worker and then the insurance reimburses after the fact. A very few are indemnity or cash policies wherein the policy pays the full benefit amount without regard to the amount of paid care. These last still require some paperwork, but it is significantly less than a reimbursement policy.


Stana Martin, PhD, founded Mrs LTC to provide a top-quality resource for clients and customers who need help with long term care claims or insurance comparisons.



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