Working With Policyholders and Their Families: A Guide to Getting Started

According to the American Association for Long-Term Care Insurance (AALTC), 7.5 million Americans have some form of long-term care insurance (LTCI).¹ While that only amounts to about 3.3% of the population, LTCI policyholders account for a much larger portion of a home care agency’s business, a portion that will only grow as the population ages.

This makes the LTCI policyholder a valued customer for home care agencies. However, these clients can also pose challenges through no fault of their own – or yours. Policyholders may not know how their policy works, and they may not understand terminology used. Some haven’t looked at their policy in years. They may not even remember where they put it. So when the time comes to activate their coverage, a policyholder can feel overwhelmed and confused and not know where to begin.

Here is where your agency can be the hero. Helping the policyholder begin their coverage and holding their hand through the initial process can earn their loyalty – while making the going easier for client, carrier, and agency along the way. What’s the secret? Establishing partnerships with both the policyholder and the LTCI carrier from the get-go. 

There is much you can do to support your new client before you even walk through the door. Prior to the first home visit, call the policyholder to cover the following questions to make sure there’s nothing standing in the way of creating your partnership. It serves as a great introduction to the kind of partner you will be.

Where’s the contract?

Does the policyholder have their long-term care insurance contract in hand, or can they locate it so they can share it with you during your first visit? (If they’re unable to find it, ask them to request a duplicate copy from their carrier.)

Tell your client not to worry if they can’t make heads or tails of their contract – you’re going to help them understand what everything means.

What are their care needs?

Confirm why they are looking for care. Make sure they meet their contract’s benefit triggers and are eligible for coverage.

Is home care covered?

Ask what the care recipient’s contract includes. Does it include in-home care? If so, what home care services are covered?

Is any licensing required?

Check whether the contract mandates any caregiver licensure or certifications. Older contracts may have such requirements and they can vary by state.

How long is their elimination period?

Confirm the length of the elimination period and whether it needs to be satisfied by calendar days or service days. Make sure the care recipient understands what the elimination period is and that they will be responsible for paying your agency out-of-pocket during this period.

Is an assessment required?

If an assessment or plan of care is required for services to begin, ask whether one has been completed. If it still needs to be done, find out who is responsible for doing it. 

Plan on reviewing the policyholder’s contract with them during the first home visit to help them feel confident that they understand how their policy works. An advantage of having caregiver staff going over these policies is that they will develop expertise in the nomenclature used and will grow in their ability to support policyholders. 

During the first home visit, you can continue to make the policyholder’s life easier by taking a few simple steps to partner with the LTCi carrier:

Call the carrier together. Have the care recipient call their LTCi carrier while you’re there. Have the care recipient give permission for the LTCI company to share information with your agency. This will allow you to ask the LTCI carrier all the questions you need answered, so the policyholder is spared being the go-between.

Obtain assignment of benefits. Ask the carrier to transfer assignment of benefits to your agency so your client doesn’t have to manage any invoicing. According to recent research performed for CareScout, policyholders greatly appreciate direct billing between the agency and the carrier.²

Put the payment system in place. Set up an electronic funds transfer (EFT) with the carrier while you have them on the line. This will help eliminate late payments and chasing invoices, meaning fewer headaches for the carrier (and you).

Helping policyholders experience a positive start to their care can give you both a boost. Your client feels much less anxiety and a great sense of relief that they’re in good hands, while you and your caregiver staff establish trust at the outset and build goodwill as you make a potentially confusing process easy to manage.

A successful start can result in a more positive experience for your staff as well, as they field fewer troubleshooting calls and interact with happier clients along the way. Everyone wins.