March 10, 2025 • 61 mins
The wave of long-term care insurance claims is rapidly approaching, and home care agencies need to be prepared. With nearly 4 million policies written between 1995-2005, we're entering a period where these policyholders—now in their peak claim years of 80-85—are seeking home care services in record numbers.
Bill Comfort, with over three decades of experience in long-term care insurance, walks us through the critical steps agencies must take to successfully work with these valuable clients. First and foremost is understanding whether your agency qualifies as an eligible provider under various policy definitions. While many policies use the term "home health care" generically, the actual definitions vary widely. Most policies specify providers must be "licensed by the state if licensure is required"—a crucial distinction for agencies in non-licensure states.
Documentation emerges as perhaps the most critical factor in successful claims management. Agencies must carefully document whether assistance with Activities of Daily Living (ADLs) is hands-on or standby—a distinction that can determine claim approval or denial. The caregiving notes must consistently reflect assistance with at least two of the six ADLs (bathing, dressing, transferring, toileting, eating, and continence) for clients to maintain benefit eligibility.
Payment structures present another consideration, with Bill strongly recommending against accepting assignment of benefits until claims are fully established. This protects agencies from financial exposure when claims are delayed or denied. Instead, establish procedures to help clients submit claims while maintaining your direct billing relationship.
Building referral partnerships with financial advisors and insurance agents offers tremendous growth potential. Organizations like NAIFA and FPA provide perfect networking opportunities where agencies can position themselves as knowledgeable resources. By demonstrating expertise in navigating long-term care insurance claims, your agency can attract both insurance-funded and private-pay clients.
Ready to position your agency as an expert in long-term care insurance claims? Learn more about obtaining the Long-Term Care Claims Professional certification to demonstrate your expertise and grow this valuable revenue stream.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This is going to be a fun, a good one, an informative
one.
These are the things I'vealways wanted to know, being in
home care almost my entirecareer long-term care.
We know we want those clients,we want them, we need them, but
we aren't always sure how tonavigate and how to get them.
So we have Bill here todaywho's going to help us with that
.
First, we're going to gothrough our housekeeping items.
(00:22):
Lisa, you want to be the one?
Yeah, for sure.
Okay, I'm not sure if Scott isgoing to be able to join us
today or not, so we'll go aheadand get started.
Speaker 2 (00:31):
And you guys already saw the chat, so if you have
anything to tell us, you canjust get in there and let us
know.
So lines muted unless you'respeaking.
Share stories, experiences,tips, ask questions, make
recommendations and tell us whatyou want to know for future.
Next slide oh hey, it's usReintroductions.
(00:53):
I guess I can start, since I'malready speaking, but I'm Lisa
Marcella.
I have been with ASN for twoyears now.
It's been a lot of fun.
It's really taken all of myexperience in home care as well
as back in the day withnewspaper and just shoved it all
into one.
So it's a very perfect placefor me to be.
Definitely, I love being a partof your guys' journey.
(01:15):
I can't stay in one lane inhome care, so this is just.
This is perfect and I lovebeing a part of it.
Thank you for letting me be apart.
Got off track there, but I'llgo ahead and give it over to
whoever's next.
Should it be Annette, you wantto go?
Speaker 3 (01:28):
Hi everybody.
I'm Annette Ziegler.
I know a lot of you here.
I have been in home care forover 20 years.
I teach the sales trainingclasses here with ASN.
I'm almost here a year.
I love what I do.
I love teaching you how to getthose private pay referrals grow
your agency.
Really glad you're here.
Very excited to have Bill here.
I told him I wish I knew himwhen I was in home care, so it's
(01:51):
going to be a great topic today.
Thanks for being here.
Speaker 1 (01:53):
Amen to that.
I feel the same way.
I'm Dawn Fiella.
I have been with ASN for closeto three years now.
I also have a background inhome care I like to say, in the
trenches of home care for closeto 20 years.
I've learned a lot along theway.
We've shared a lot of that withyou.
We share a lot of that with youhere in Mastery.
Thank you for joining us todayand allowing us to be a part of
(02:14):
your journey, and thank you forall you do with your seniors out
there and the care and supportyou're providing them.
I don't know if Valerie isgoing to join us today.
You're providing them.
I don't know if Valerie isgoing to join us today.
She is a co-owner and founderof Approved Senior Network.
She's a nurse by trait andshe's been doing this since 2008
.
We do a lot of websites andonline marketing and SEO, in
(02:35):
addition to the feet on theground training.
So we'll keep going, lisayou're up again.
Speaker 2 (02:40):
Okay, how to watch the meetings you missed.
What you're going to do is nextslide.
I'm not driving, so All right.
So you want to go log into theforum and did I miss a slide
there?
So home care marketing andsales support forum is right
here.
There you go.
Home care, home care salesforumcom.
(03:02):
There we go.
And your username is your emailaddress.
So whatever you signed up withus at the beginning with is your
.
That's your email address, andthen you should have got a
password sent off to that email.
If you don't remember it orjust can't find it, you just can
click on the forgot yourpassword option there, and this
little square is what it'll looklike when you get in there.
And then what you want to do isgo straight to where that arrow
(03:25):
is pointing.
It says learning.
If you go to the discussion, ofcourse you can go in there too
and you can talk to all of usyour colleagues, peers, all of
that, ask questions, get ideas.
But you want to go to thatlearning to get into the master
masteries, sorry.
And then, okay, there we go.
Cool, we changed the slide.
I forgot that we did, but thereyou see we have 2024 over there
(03:46):
.
But you want to go into that2025, click on there, open that
up and it will give you a listof different.
For example, here's January2025 and the two that we did
that month, and then as youscroll down you can see February
and on as we get them out.
All right, the mobile version.
So hopefully everyone'sdownloaded this already, but
it's Colab app and it's with aK-L-A-B how to use it and what
(04:11):
it's for.
So you'll get here.
It's called Lead Connector byold Colab, by Lead Connector,
and here is one for Apple.
So you can if you have Apple oryour Samsung, but it looks
pretty cool on your phone, youcan see here.
So there's a couple ofdifferent links.
Yes, yes, and boom, okay, soyou can go on.
(04:34):
So you see there's a wholebunch of different things going
on here.
But right here, the first thereis a where you can just click
on video so you can actuallywatch the replay.
You can also go to the nextslide over and you can actually
click on different links withinthe replay so you can go into
the leave behinds or anythingelse there.
I can't see the bottom of thescreen on my oh, okay.
Speaker 1 (04:59):
Down in the bottom, all of you see the circle blue.
Speaker 2 (05:03):
Yeah, now I can see it.
Yeah, it's kind of at thebottom there.
It's almost like all thedifferent pages, and so you have
the homepage of discussion andcircled right there is learning
and that's all you have to clickon and then you can get here.
So here you can see different,all the different features that
we have, so you can askquestions, you can see other
people's leave behinds or anyideas that they had, you know,
(05:25):
used and shared with us.
You can share anything on hereand you can ask any questions at
all and we usually get back toyou very quickly.
We also did something reallycool because we listened and we
put it to use, but we created ahomecaremarketingnewscom store.
So this store, we did thelegwork for you, no-transcript,
(06:11):
and now we're up.
Speaker 1 (06:13):
So we have Bill Comfort, csa, cltc, ltccp.
He's got lots of credentialingthere behind his name.
He is an independent long-termcare specialist at Comfort
Long-Term Care.
He is in Raleigh, durham,chapel Hill, North Carolina and
beyond.
34 years in the insurancebusiness, former radio and TV
(06:34):
journalist that's very cool.
His mission is to helpindividuals and families protect
against and financial costs oflong-term care disability.
He consults nationally withprivate duty home care industry,
educating care providers onlong-term care disability.
He consults nationally withprivate duty home care industry
educating care providers onlong-term care insurance claims,
and he's certified in all 50states.
So that's awesome.
We've got an agenda here.
(06:54):
Before we get started, though,we do one giveaway every meeting
of customized leave-behinds.
This time you will get Aprilleave-behinds.
If you would like for us totake all the April leave-behinds
.
This time you will get Aprilleave-behinds.
If you would like for us totake all the April leave-behinds
we're going to share with youlater, and put your phone number
, your logo, your colors on it.
We need you to type the wordyes in chat.
There is one little thing,though you have to promise to
(07:18):
take pictures and send them tous so we can share them with
everybody here at Mastery.
So please type the word yes ifyou want to be the winner.
There will be one winner forthe April Leave Behinds.
Type the word yes in chat andremember you have to take
pictures.
We will be tracking you downand that's going to start
tracking down those Februarypeople.
She's already got a list.
Okay, the agenda for long-termcare insurance.
(07:40):
This is a step you guys havealways wanted to know how do you
build strong relationships withlong-term care referral
partners to receive morelong-term care insurance clients
.
Learn the process foronboarding long-term care
insurance clients to home careservices, enabling faster claims
and stronger partnerships withreferral partners, and then
understand the different paymentstructures between long-term
(08:01):
care carriers and home careagencies, including direct
payments to the agency versusclient-paid models.
So Bill's going to go throughand cover all of this.
Please type your questions youhave for Bill in the chat and we
will make sure that they getanswered.
Welcome, bill.
We are thrilled.
I feel like I've waited 20years to hear this.
Speaker 4 (08:20):
We are thrilled to be here today.
Yeah, thank you.
I feel like I've waitedprobably 15 years to be a part
of this.
I actually, Valerie and Iworked together back in probably
2001.
There she is we're getting theband back together, Valerie.
Speaker 5 (08:38):
You know what I cannot believe.
It's been 25 years.
That is weird and crazy that wecould possibly be that old.
We were young sprites when wefirst met and we're all into
long-term care and stuff.
Speaker 4 (08:50):
And we're still in long-term care.
So I think that says somethingeither about our patient's
virtue, or maybe just stupidity,I'm not sure what.
Speaker 1 (09:02):
All right, bill, I'm going to be your driver, so just
tell me when you want the nextslide to come up.
And you're up there, you go.
Speaker 4 (09:10):
This is great and let me start by saying I wear two
hats in my professional life.
My main hat, my day job,depending on which day it is
selling long-term care insurance, engaging with clients, their
other advisors about planning inadvance for care and buying
(09:30):
long-term care insurance to helpfund that in whatever form, in
whatever way, and that's.
I've sold long-term careinsurance for more than 30 years
.
Valerie was part of helping tostart a specialty agency in St
Louis back in 2000.
So it's really all I've done inthe insurance business for the
last 25 years.
My other hat is as a continuingeducation instructor and I've
(09:56):
taught for the CLTC Certified inLong-T care program for 23
years now, which is really foragents and advisors planning for
care how to engage clients inthat advanced planning
conversation.
Obviously, long-term careinsurance is part of that.
(10:17):
But starting about 16, 17 yearsago I began doing private
consulting with the home careindustry.
In doing training aroundlong-term care insurance but
looking at it from the claimsperspective, particularly from
the view of a home care provider, years ago I started a
(10:41):
designation that I really justused for my private consulting
clients called LTCCP Long-TermCare Claims Professional.
It's an in-depth training inunderstanding long-term care
insurance from your viewpoint,what happens at time of claim?
(11:02):
What do you all need to do,what do you need to be aware of?
And we're going to touch on alot of those issues, at least in
an introductory way, today.
We're also going to share withyou how you can take the course.
We opened it back up, updatedit on the third edition of the
textbook last December, so it'snow available publicly and we've
(11:22):
got a discount for those of youin the ASN network.
That's my business and thereason this claims discussion is
so important.
Whatever level of clients eachof you have in your offices,
your agencies that havelong-term care insurance, over
(11:42):
the next 10 years, long-termcare insurance over the next 10
years, the number of people whoare going to need care with
long-term care insurance isgoing to significantly increase.
I don't know if it'll double,but it's going to be a
measurable increase lookingforward, particularly over the
(12:04):
next 10 years.
And the reason is becausethere's about 7 million give or
take people who have long-termcare insurance and half, a
little more than half, of thosethree and a half pushing 4
million policies pushing 4million policies were written
(12:31):
just in the 10 years between1995 and 2005.
Those were the largest salesyears for long-term care
insurance.
We peaked in 2002.
750,000 individuals bought apolicy just in 2002.
And let me give you acomparison Last year it was
about $150,000.
And that includes regularlong-term care insurance and
(12:54):
just life insurance with aspecific long-term care rider.
But here's the impact for youall today.
Think about a 60-year-old whobought her long-term care
insurance in 2002.
How old is she today?
She's 83.
(13:14):
What's the peak claim years 80to 85 is the very top of the
steep bell curve when long-termcare insurance claims begin.
75 to 85, you guys know theages of the folks that are
coming to you.
So we are going to see thesepolicies that were written 20 to
(13:38):
30 years ago.
Those are the policies that arecoming to claim today and it's
a bigger wave, a bigger cohortof older enforced policies than
we've ever seen in long-termcare insurance.
The carriers are scrambling tobe ready for this.
(13:59):
They're also pushing back insome ways, because this is where
the money starts going out thedoor for them as well.
So being savvy for your businessand in partnership with your
home care clients, I think isreally important and that's what
we're really going to focustoday on.
So go ahead Dawn.
So just to start, there's threelevels, so we're going to look
(14:24):
at each of these very generally.
But the first thing is tounderstand is your office, your
agency, even going to be acovered provider?
Questions around this.
(14:46):
We were talking before weopened the webinar today about
things like licensure and so on.
What I want to focus on is thismiddle point.
What does your client, yourhome care client, who owns a
long-term care policy, what doesher policy actually say?
Policy actually say?
Not on the schedule page,because most of them say home
(15:07):
health care, and I know you'renot home health care, but
long-term care insurance usesthat term very generically.
So the best advice that I cangive you and part of what this
LTCCP training does is reallydisassembles long-term care
(15:29):
insurance contracts to show youwhat to look for, where to look
for it, how to read thecontracts in detail, Because you
want to look and see what ishome health care generally and
how is a home health care agencydefined.
And there's a whole range ofdefinitions, particularly
(15:52):
policies that were issued in themid to late 1990s After about
2000,.
We have a lot morestandardization, but again we're
just beginning to get claimsfrom the most modern era where
there's more consistency acrosspolicies.
So this cohort this claims wavethat's coming has policies with
(16:14):
home care definitions that areall over the place.
A covered agency says you mustbe licensed by the state and
(16:35):
you're in a non-licensure statelike Arizona or Missouri, you
might not be a covered provider.
It's possible, but a lot ofpolicies have what's called an
alternative plan of careprovision where the client can
negotiate your client, thepolicyholder can negotiate for
(16:56):
an alternative payer.
And the problem is Valerie thisis going back probably 15 years
, but CNA was notorious back inthe 1990s for policies that said
have to be home health carelicensed to bill Medicare?
Basically there were like twohome health agencies that had
(17:25):
the proper licensure, that wereeven willing to staff, willing
and able to staff custodial care, private duty shifts for three
or four or eight hours a day.
Carriers have gotten better.
Cna has moved away from beingso strict on this and so that
kind of is an alternatenegotiation, but it's a
(17:48):
negotiation and the carriercould say no, probably the most
common language.
And this is where you need tobe very savvy.
Don't just take your client'sword, the policyholder's word of
what they heard the insurancecompany say to them.
(18:09):
Get with your client and sitthat either get a copy or sit
down with them at their kitchentable and look at their actual
policy, like the 40 or 50 pagepolicy, and find the page that
defines a home healthcare agency, and the language that I think
(18:34):
you're going to see that's themost common is it says you have
to be licensed by the state iflicensure is required.
Now I've seen carriers thathave just loaned past that.
Look, what are they trying todo?
They're trying to at leastpostpone starting to pay for a
(18:56):
claim.
Maybe they'll end up paying forit six months a year down the
road or when the person goes toassisted living or skilled
nursing, but that saves theinsurance company money.
Look, I could be a happy cynicabout my own industry here.
If the definition says industry.
(19:20):
Here, if the definition saysmust be licensed if required by
the state, you need to have, ifyou're in a non-licensure state,
a system of reporting with somedocumentation to the insurance
company, to your client, to giveto the insurance company or you
provide directly to theinsurance company as part of the
process that validates this.
And an idea that I got way backin the early 2000s back in St
(19:47):
Louis was a local agency inMissouri wasn't licensed because
it wasn't required.
And what this owner did waswrote to the state it's probably
Department of Health and HumanServices that licenses the
skilled home health agencies,the Medicare agencies right
(20:08):
Wrote to them and said do I?
Basically said do I need tohave a license to do private
duty custodial home care inMissouri?
I'd like a letter explainingthis.
And he got a letter back thatsaid in Missouri licensure is
(20:28):
not required.
And he kept a copy of thisletter and it didn't matter what
the definition said, every homecare claim, every client he had
with long-term care insuranceexcuse me, he would send a copy
of that letter in so you mightexplore that option.
Your state dawned like inArizona as we were talking
(20:50):
before we started.
Some policies say you have to belicensed if it's required by
the state.
If not, there's then a list ofcriteria and almost every time
I've seen the list, your agencyis going to meet that criteria,
(21:11):
especially if you have a nurseon staff to be able to supervise
, to write plans of care, dotraining, those kinds of things
which most offices do.
If you don't have an RN onstaff or on contract that you
can show, that's a little tough,but in my experience most
(21:32):
agencies are going to have that,where the one kind of
organization of how you'restructured where there could be
an issue is if you're truly aregistry where your providers,
your caregivers, are 1099employees.
(21:53):
That could be an issue becauseyou are not an organized
professional agency.
The only exception would beFlorida, and Florida has very
unique, specific laws relatingto long term care insurance.
It's not in the contracts butbasically behind the scenes.
The insurance law says inFlorida a registry must be
(22:17):
considered the same as a formal,organized home care agency.
That's of course irritating ifyou are a formal agency with
employed caregivers because theregistries maybe end up being
more competitive.
But we're looking from adifferent angle.
So obviously you have to livewith your state requirements for
(22:40):
your business.
North Carolina has a licensurefor private duty custodial home
care, so that covers a multitudeof different definitions,
because some policies just sayyou must be licensed by your
state definitions.
Because some policies just sayyou must be licensed by your
state.
Where we see the problems againis you have to be licensed as
(23:04):
home health care, skilled care,some say to bill Medicare, or
certified by the JointCommission, which is effectively
the same thing.
That's what you want to lookout for.
I think more and more as we'reworking from kind of 95 policies
issued in the mid-1990s forward, most of you are going to be
(23:25):
able to navigate around thesedefinitions.
But you have to know what thedefinition is and sometimes
you've got to go to bat for yourclient, the policyholder, and
either help them say, or get onthe conference call and say to
the claims person we meet everypiece of the definition on page
(23:48):
14 of Mrs Jones' policy.
That's not, that's generallynot.
I had this come up recently.
We have a standard for how weevaluate it and I said to the
person I said I don't care whatyour standard procedure is.
This specific policy says thisand it should be covered.
(24:11):
We'll have to look at that.
I said get a supervisor on thephone right now, right, covered,
we'll have to look at that.
I said get a supervisor on thephone right now, right.
You know the drill, but that'ssometimes what you have to do.
Let me pause here, dawn, andsee if anybody has any questions
or kind of examples around usthat we ought to discuss before
we move on.
Speaker 1 (24:28):
I do have a question.
So there is Victoria takeslong-term care insurance.
However, they do not bill theLTC because oftentimes they
don't pay.
Do you have any tips?
We have to providedocumentation and 3D, adls et
cetera.
I know we would get moreclients if we build the company
directly.
Speaker 4 (24:48):
Yeah, let's go to the next slide, because that's
something we had talked about.
Let me address.
Leave this slide up.
Let me address the questiondirectly.
So what you're describing inthe direct billing or direct
payment from an insurancecompany, that's called
assignment of benefits and maybea lot of you probably heard
(25:10):
that term.
So assignment of benefitssimply means the policyholder,
your client, signs a form orwrites a letter that says,
instead of me, the policyholderreceiving the check each month,
I just want you to send it to myprovider directly.
(25:31):
Same things have to happen.
You have to still showcaregiving notes and invoices
and the insurance company has toreview and adjudicate all of
that month in and month out.
So assignment of benefits canbe tricky.
However, I never recommend thatyou take assignment of benefits
at the very start of a claim.
(25:51):
Are you even an eligibleprovider?
Has that been determined yet?
Is the policyholder evenbenefit eligible?
I've worked with home careagencies where they've gotten
two, three months into servicesand basically the person's not
even eligible to go on claim yet.
And the client crosses theirarms and says well, you agreed
(26:14):
to take the insurance, it's notmy problem, they're not paying
Now, you got to sue.
The client crosses their armsand says well, you agreed to
take the insurance, it's not myproblem, they're not paying.
Now you got to sue the client.
It's just a mess.
So this idea of acceptingassignment should only be done
after the claim started, thatyou and the client know they are
benefit eligible, approvedWe'll talk about that in a
(26:37):
moment that you're an approvedprovider and that elimination
period, that 60 or 90 daysthat's already run.
Basically, don't take anassignment of benefits until
your home care client hasalready received at least one,
(26:59):
if not two, checks from theinsurance company for your
services.
That's my bright line advice onthat.
It can, let's say, the carrier,six months in, does a review
and they dig through the notesand it doesn't appear that the
caregiver is providing any ADLsupport, for example, and they
(27:23):
pause the claim.
They say it doesn't look likeMrs Jones is eligible anymore.
So it's probably a mistake.
But there could be a month ortwo of delay.
Often they will go back and payin arrears, but you all know
you can't float a month or twomonths worth of invoices that
(27:43):
way without consistent paymentcoming into your business.
Look, it's a business practicedecision.
I'm hearing more and more homecare offices, agencies, say
we're not doing assignment ofbenefits anymore.
We work our butts off todocument everything properly for
(28:04):
long-term care insurance, tosend direct to the insurance
company the caregiving notes,the plan of care and the weekly
or monthly invoices so they cansee everything.
But our deal is with our client.
They pay us and we help theclaims go through, but the
(28:25):
client gets reimbursed.
By the way, that's howlong-term care insurance is
designed to work Back in the 90sand the policies we sell today.
They are not designed to payyou.
Speaker 1 (28:44):
And you could even use that with clients.
Speaker 4 (28:48):
Yeah, go ahead.
Speaker 1 (28:48):
I have a question about that.
So how long might the clientwait to be reimbursed by the
insurance company?
Because that's the next thingthey're going to ask Okay, I'm
paying you, when am I going toget paid If you're doing all the
things?
We're just sending the ADLs,we're sending the plan, we're
done all the check is all done.
How long will they be waitingto get payment?
Speaker 4 (29:09):
It's really a question when you're at the very
start of a claim.
They've never been on claimbefore they're starting the
claim.
Most claims 80% of alllong-term care insurance claims
start at home.
That's not surprising to any ofus.
So if they have a 90-dayelimination period, some people
(29:30):
call it a waiting period, butthat could be a misnomer or lead
to some misunderstanding.
The 90-day deductible periodwhich they chose at the time
they bought the policy could bea little shorter, could be a
little longer, but 90 days 100days is the most common that
you're going to see.
There's no benefit paid for 90days, whatever that period is.
(29:55):
But let's use 90 in the exampleand let's say during that 90
days the company is efficientlyprocessing and agreeing that
your client is benefit eligible,that you're an eligible
provider, that they're countingthe days and at the end of 90
(30:19):
days the client has been payingout of pocket because it's their
deductible period.
The elimination period is thedeductible in long-term care
insurance.
So most people think they'regoing to get a check on day 91.
I'm sure Most policies are whatare called reimbursement, so
(30:40):
they reimburse for expenses thathave already been approved and
paid.
First check you have to get tothe end of the fourth month,
(31:02):
with services billed and paid bythe client during the fourth
month.
At the end of the fourth monththose invoices go to the
insurance company.
They review them.
That takes a week or 10 days.
They put it into their paymentsystem, which maybe takes
another week or 10 days.
So what I tell people?
Best case scenario at the startof a claim where you have to
(31:26):
get through that eliminationperiod, they are not going to
see their first check for atleast five months.
Speaker 1 (31:32):
Okay, wow, we've got more questions.
Yep, Go ahead.
If requested by long-term carefor an assessment copy of a care
plan or any other documentation, how can we charge for the time
it takes us to do that start ofa claim and how much do you
suggest for one hour assessment?
Speaker 4 (31:51):
That's an interesting question and I'm going to give
you an opinion.
That's just my opinion.
I think there's an ethicalquestion here that you have to
sort out in your business andhow your business is organized.
Are onboarding a home careclient with long-term care
(32:13):
insurance?
You have a responsibility,bill's opinion, to do whatever
it takes from your role as thehome care provider to get to the
client and or the insurancecompany the information that's
needed for them to use thispayment source.
(32:35):
Most agencies don't bill forthat time.
Might it take some extra timeand effort?
Yes, but recognize this is alsoa client.
If you do it, they have extraresources, they have extra funds
.
A large agency I just wastalking to the owner large
(32:55):
agency in my area here and hehas a significant number of
long-term care insurance clients.
He said on average, the monthlybilling for his clients with
insurance versus just privatepay out of pocket versus just
(33:20):
private pay out of pocket, it's50% higher on average.
So I think it's worth it foryou to do that.
Now let me here's my caveat,and I think where the ethical
question is if you have a homecare agency and you provide
already like a separate caremanagement service that you bill
for on an hourly basis.
If that's part of your businessstructure, then maybe you tell
(33:47):
the person look, this takesextra time and this is going to
be a care management servicethat could take an extra hour or
two and you bill your hourlyrate.
But if you don't operate thatway, I would not charge an extra
fee.
I think it's part of the costof doing business and working
(34:08):
with long-term care insurance.
Bill's opinion.
Speaker 1 (34:12):
Okay.
Speaker 4 (34:12):
Interesting question.
Speaker 1 (34:14):
Yeah, We've got lots of questions.
I'm having issues with aninsurance company not noting if
elimination period is servicedays or calendar days.
Speaker 4 (34:24):
It's in the contract.
It's one of those things youhave to find, smoke out and
identify in the contract.
So let me give you an exampleGenworth, which is the largest
in-force company.
They've got a million twopolicies in force and again,
probably half or more of thosewere written between 95 and 2005
(34:47):
.
And those are coming to claimtoday.
They have policies with a zeroday home care elimination period
, meaning benefits start day one.
They have policies that have aservice day elimination period
and they have policies wherepeople chose what's called a
calendar day as a better option,a more liberal option, as a way
(35:10):
to count those days.
Those days you have to look inthe contract and in my world and
my advice to you don't evertrust what the insurance company
is telling you.
You've got to verify it.
In fact, I would not advice toyou, I would not onboard a
long-term care insurance clientif they will not let you see
(35:33):
their actual policy.
And I know sometimes that's atrust issue.
They're afraid if you see it'slike I'm going to show you my
bank statement or something,you're afraid you're going to
overcharge them and use up theirpolicy too fast.
Look, you just got to overcomethat kind of trust and new
client engagement.
(35:54):
Maybe they'll give you a copyof it, maybe you again sit down
with them at the kitchen tableand you could even use some of
these issues as a way to explainwhy you need to do it together.
The way the elimination, the waythe 90 days are counted, mr and
Mrs Jones, we have to know thatfor home care, because in some
(36:19):
policies you have to hire usseven days a week that's service
days to get 90 days in threemonths.
Your policy might just requireus only to be here one day a
week and we need to worktogether on this.
And I got to tell you theperson on the other end of the
800 number, john, excuse me,genworth administers today in
(36:45):
their claims department, whichis in-house, they administer
close to a thousand differentcontract forms issued by
Genworth, ge, amex.
They also manage the TravelersBlock of Business and dozens of
(37:06):
other little companies that haveoutsourced claims to Genworth
as their TPA.
So that claims person, they'renot reading a specific contract,
they're working off a guidelinescreen.
Speaker 1 (37:19):
Right, okay, we've got some more.
After the waiting period,elimination period and claim is
approved, does the policyholderstop paying their LTC premiums?
Speaker 4 (37:29):
In most cases.
Yes, the term is called waiverof premium and most policies
waive the premium after theelimination period once benefits
become payable.
Some policies you got to goanother 30 days or 90 days after
(37:50):
the EP, but most commonly afterthat elimination period's run.
But most commonly after thatelimination period's run,
premiums are forgiven.
If a policy was issued in the1990s, anywhere in the 1990s you
want to look closely at thisWasn't common.
(38:14):
But some policies only waivethe premium if you're in a
facility, but they don't waiveit for home care.
So it's not universal.
But most policies I think thatyou run into will and, by the
way, that's a great thing to beable to show a client in their
policy if you're reviewing itwith them to help, particularly
if they're saying things like wedon't really want to start
using our policy now, we want tosave the benefits for later.
(38:38):
You hear that I'm hearing a lotof offices ask that question to
me and one of the reasons tostart a policy today is you get
to stop paying premiums and, bythe way, you don't have to use
the whole benefit.
You could choose.
If they have 6,000 a month andyou're only billing them 3,000,
(39:00):
they're only drawn down 3,000 amonth, for example.
Or let's say their policy is$6,000 a month and you're
billing $6,000 a month or more,they could choose to only submit
half the claims forreimbursement and it just it.
Generally, from a financialplanning standpoint I get it.
(39:21):
I get the emotion behind it,but from a financial planning
standpoint it makes no sense tonot use your policy and your
policy's benefits as soon aspossible.
But the waiver of premium oftengets people's attention.
So that was a great question,good.
Speaker 1 (39:38):
Great, that's all the questions we have.
We have a few more minutes, sogo ahead.
Please tell us more.
Speaker 4 (39:44):
Yeah.
So let me touch on what we haveon the screen here We've talked
about.
Are you a preferred provider?
Benefit eligibility is reallythe number one issue at time of
claim.
Nothing happens, theelimination period doesn't run,
days of your service aren'tcredited if they're not benefit
(40:06):
eligible, and that's the twophysical activities of daily
living or, separately,supervision for a cognitive
impairment.
Most policies and we don'treally have time to get into
sort of the 1990s versus what'scalled tax qualified policies,
(40:27):
which have some subtledifferences, but most policies
have two out of six activitiesof daily living Bathing,
dressing, transferring,toileting, eating and continence
are the six.
Speaker 1 (40:43):
But we have to be doing two of those for them to
qualify.
Speaker 4 (40:47):
But we have to be doing two of those.
For them to qualify, they haveto need assistance with two of
those correct.
Speaker 1 (40:52):
Okay, got it.
Speaker 4 (40:53):
Now this is critical.
It's probably the biggestmistake that I see being made in
home care agencies today whenit comes to claims eligibility
(41:15):
and that is not understandingand not properly recording in
the plan of care and notconsistently charting by the
caregiver whether the help ishands-on help or standby help.
Totally, most long-term careinsurance will approve a claim
or a loss of an ADL.
(41:36):
If it's simply standbyassistance, how do you know?
You have to read the contract.
Especially in the 1990s therewere policies that were hands-on
only.
But I think in the claimsyou're going to see today and
looking forward, the majorityare going to measure an ADL loss
(41:57):
on a standby basis.
You have to chart it.
I have three claims appeals I'min the middle of right now
where somebody been on claim fornine months a year and a half
in one case and the insurancecompany did a review and said
they're no longer benefiteligible.
They only need help with oneADL.
I reviewed four months the mostrecent four months of care
(42:19):
notes, daily care notes.
There was not one mention inthose care notes or check boxes
from the caregiver in the housethat they ever did any more than
one of the insurance ADLs.
Now they tried to tell me thatwell, they do transferring all
the time they drive her toappointments.
Transferring is not an ADL forlong-term care insurance.
(42:41):
You got to bathing, dressingtransferring.
Those are probably the threemost common.
Toileting is actually right upthere because of somebody's
mobility impaired.
This is interesting.
Most people don't know this.
It's new on my radar screen aswell.
The last few years of toiletingsays the ability to safely get
(43:07):
to and from and on and off thetoilet and obviously hygiene.
But if somebody needs helpgetting in and out of a chair or
a bed, which is transferring,they probably also need help
getting on and off the toilet.
There's two ADLs right thereand it says to and from.
If they're mobility impaired,they might be toileting impaired
(43:31):
and remember it's probablystandby assist and it has to be
both in the written plan of careand it's got to be reflected
consistently in the caregiver'snotes, however those are charted
or reported.
Speaker 1 (43:49):
You're so right, bill .
We had a couple of claims thatwe had to fight.
Also, you guys have to reallywatch what the caregivers are
charting.
If you have an LTC client, thatyou need to have them stand out
somehow.
If there's a new caregiver forthree days or something, they
have to be alerted to do this.
You've got to check over andover because it is not worth
(44:10):
having to figure out later.
Speaker 4 (44:12):
It is a nightmare.
Let's change the slide here.
I want to make sure we coversome of the things or that.
So yeah, just to that lastpoint.
There is a training issue herewith the caregivers.
I had a person share in theLTCP class last week that the
(44:35):
business manager of the agency,if they have a long-term care
insurance client, every carenote is reviewed in detail
before it's sent to theinsurance company.
And if they know there's two orthree ADLs on at least a
standby basis and they're seeingthat one of them's not being
(44:58):
charted, they will go back andwork with the caregiver to amend
those notes before they go tothe insurance company.
Speaker 2 (45:05):
Absolutely.
Speaker 4 (45:07):
Very valuable.
I want to talk a little bitit's really this screen and the
next screen about some ways youcan use your knowledge your
expertise, if you feel like youhave it with long-term care
insurance for marketing and goon to the next screen now, and
(45:28):
these are some different groupsobviously you can network with,
but I want to focus specificallyon financial advisors and
insurance agents as potentialreferrers to you.
You want to reach out to thesegroups.
Want to reach out to thesegroups not just asking for them
(45:51):
to refer their long-term careinsurance clients, who need care
, to you, but insurance agentsand financial planners.
They're going to have clientsin their 70s and 80s that don't
have long-term care insurancebut who need care.
How about if you're thatfinancial planner's go-to
resource about all thingsknowledgeable about home care?
(46:12):
See, you're going to getreferrals for private pay
out-of-pocket clients from them,but they are also going to know
when they have clients withlong-term care insurance.
So you're covering both bases.
And let me give you two ideas.
Insurance agents have a nationalassociation that many of them
(46:36):
belong to called NAIFA N-A-I-F-A, and it stands for Insurance
and Financial Advisors.
Whatever NAIFA N-A-I-F-A youcan Google it.
Google NAIFA Scottsdale I'llbet there's a local chapter in
the Phoenix, scottsdale orwherever you are, and they have
monthly or quarterly meetings.
(46:57):
They often will welcome a guest.
Just go and network and havecoffee.
They're always looking forspeakers.
If you did a 25-minutepresentation on the difference
between home health care andhome care and what pays for what
and what doesn't, you'll blowtheir minds and you'll get their
(47:20):
attention and you'll buildthose relationships as
relationships.
Speaker 1 (47:27):
That's a great idea, and we have a lead behind guys.
Speaker 4 (47:29):
That's the differences between non-medical
and medical home care.
I'm telling you a 20 or 25minute presentation at one of
these meetings.
It would really resonate.
So the other organization Iwant to share with you is FPA.
Stands for financial planningassociation.
That's what CFPs, CertifiedFinancial Planners, belong to.
(47:51):
Pa is more financial advisor,financial planner oriented, but
I mention it because they alsohave local chapters with regular
meetings all over the country.
They welcome visitors like youall as well.
Speaker 1 (48:11):
And Annette's put those in the chat.
Guys, the links are there foryou in the chat so you can copy
and copy them.
Speaker 4 (48:17):
So I think go one more slide here.
This is the shameless plugslide from your presenter today.
What we've done is in our 40minutes or 45 minutes here is
just scratch the surface.
You've gotten the key ideas ofthings to look for.
This is the course I developed10 years ago and that we've
(48:38):
recently relaunched Long-TermCare Claims Professional.
If you sit through a live Zoomclass it's five hours.
You're probably going to spendanother couple hours with the
textbook and the online reviewquizzes before you take the exam
.
We're going to have onlinerecorded videos that you can
(49:00):
self-study from.
They should be open andavailable in the next week or
two for this.
It's a 140-page textbook that'sfull of tips, not just
definitions, not just how thepolicy works, but what do you
have to do as a home careprovider, especially regarding
(49:22):
these different definitions,problematic definitions or the
plan of care, and examples wherethere can be issues and so on.
So that's all part of thiscourse.
You can see the website thereltccpcom.
There's a lot more informationthere and I'm extending a
discount to everyone in the ASNnetwork for 150 off the regular
(49:43):
tuition.
You can see the coupon code and, dawn, you're welcome to share
this with everyone in yournetwork and if you have a
question, if you go to thewebsite, hit the contact form.
I'm glad to connect with youthat way as well.
It is pre-approved forcertified senior advisor and
(50:06):
certified case manager.
Renewal CE credits.
Cmc what is it?
Care manager certified thoseare pending, hoping any day to
have those Again.
If you or someone in youroffice would benefit from the
course and they hold any ofthose designations, they can get
(50:28):
some renewal credits for theirdesignation.
Speaker 1 (50:31):
Thank you, bill, so much for that information.
It was really helpful.
Thanks for being here with us,too, today.
I think we might go to the May.
You good doing the May leavebehinds Lisa, yeah, hey guys.
Speaker 5 (50:48):
Yes, hey, can I say I'd like to say something on
behalf of Bill or about beforewe go on to the.
I know we're going to talkabout leave behinds and that's
awesome.
I will say this as a registerednurse, I have played all of
these roles, so I have been theperson that goes out and
certifies that they areavailable to go on claim, or
(51:09):
they should go on claim, thatthey meet all the criteria.
I've done that.
I've gone to houses and saidyes, filled out all the
paperwork.
There's certain organizationsthat hire nurses to go out and
do that sometimes.
I've also been the long-termcare insurance agent, which is
today weird because I still getnotices of my clients who have
not gone on claim yet and theymust be 100 years old by now.
(51:31):
And then I also have known Bill, like we said in the beginning,
for 25 years, and he isprobably one of the most trusted
folks in long-term careinsurance across the United
States.
There is no doubt in my mindthat we've been waiting for
something like this for a verylong time a class that home care
(51:53):
agency owners or their businessmanagers in their office or
their administrators or somebodycan take and then implement and
market the fact that they'reexperts in long-term care
insurance claims To be able tosay that have the certification
(52:15):
behind your name or yourorganization's name, and that
opens up a lot more of thislong-term care insurance
business and you won't be afraidof not getting paid.
You'll know exactly what to sayand what to do in all these
different little nuanced issuesthat come up with these things
and I'm not saying anybody'safraid to do it, but different
little nuanced issues that comeup with these things, and I'm
not saying anybody's afraid todo it, but you don't.
Once you go through the class,you don't risk not being not
(52:36):
understanding a policy and youalso open yourself up to having
lots of resources, because I'msure, along with the class, you
do have lots of folks you couldtalk to or send an email to and
say, hey, we're having troublewith this.
What's your recommendation?
We don't have guest speakersvery often, but we wanted to
have Bill on because this issomething that I feel like is
(52:58):
very important for home careagencies to know and understand
to increase their revenue andtheir bottom line.
So I hope that this was helpfulto everybody and I hope you
consider that his class might bea really good addition to your
accounting team, to you, towhoever your salesperson is out
there, whoever is opening upcases, and add it to your
(53:20):
marketing materials.
Don't just say we acceptlong-term care insurance as a
one line bullet.
We've got a lot of clients whomake a very big deal about how
they work with long-term careinsurance on their website, and
you should do that too.
It eases the mind of the adultchild who's looking for care to
know that you understand thisstuff, because it can be
(53:42):
complicated and they don't knowwhat they're looking at.
So anyway, good points, lovethat.
Speaker 4 (53:54):
Thank you, Valerie, and listen, thank you all for
your time and ASN for theopportunity here I will say just
continuing that discussionabout the class.
If you want multiple peoplefrom your office to take the
class, reach out to me because Icould do an additional discount
for addition for multiplepeople in the same office.
So, Valerie, thank you so much.
I that kind words and Iappreciate it.
It's taken us way too long toget to today, but I'm glad we're
(54:16):
here.
Speaker 1 (54:18):
That's awesome.
Speaker 5 (54:19):
Glad you're here.
Speaker 2 (54:20):
Okay, I'll leave you guys alone, so you can Okay, so
we should just skip to May ToMay.
Speaker 1 (54:28):
They're the new ones and we'll go through March and
April again next time.
Speaker 2 (54:31):
Okay, and then maybe, too, we might want to just
anyone who is interested ingetting the leave behinds, for
what are we doing for April.
If you would please, in the chat, just say yes, and if you're
interested in getting these are,it's all of them and we're
going to customize them and sendthem out to you.
(54:52):
So just yes in the chat and,okay, may leave behind.
So the idea behind this and I'mjust trying to go really fast
this is older Americans month isMay and so the I guess the
theme this year is flip thescript on aging and age how you
want to, and aging doesn't haveto mean stop doing what you want
(55:13):
to do or stop having fun, andso this is designed to, and it
has basically 20 ways to helpkeep seniors young at heart, and
it just gives differentexamples of things that they
could be doing.
And you want to take this outand just maybe this could become
a part of the move-in brochuresor any of that type of thing,
and this should be able to getsomeone the social worker,
(55:35):
director of nursing care, theexecutive director to come out
and talk to you, because youreally want to be able to
include this and this will helpthem to help their seniors help
figure out things to do withinthe community or other.
Just I'm trying to get it toyou as fast as I can.
Speaker 1 (55:51):
They also can like print.
You can give them a lot of themand they can give them out to
the adult children that they'reworking with for ideas for their
parents, too.
Right, I love this handout.
Speaker 2 (56:03):
Yeah, you helped me with it, thank you so much.
And you guys can go in with allof these.
You can go in and customizewith your logo, your information
, at the bottom of course, andthere's a link to canva and
google, uh, next up, and this isjust really.
I wanted you guys to be able tosee what these words are,
because I had to put a wholepage into 30, 30 font or
(56:25):
whatever, so you can just see 20, 20 ways.
Stay connected, join clubs,attend events, call family.
Number two is learn somethingnew, a language, a hobby,
something different.
Three stay active, walk daily,volunteer, laugh often, express
creativity and more.
Lots more.
(56:45):
Nurses week Don't forget nursesweek 6 to may 12.
I just want to say thank youfor them being all the
difference.
And then it gives a little bitof detail on how our caregivers
can help care for patientsneeding one-on-one support,
right, and then again you cancustomize any of these and we
have some cool little giveawaysto go with these too.
Yeah, they're in the giveaways.
So I was totally on justlooking all over the place.
(57:09):
I was so excited about this,but I love these bags.
I'm so excited to find thesebags and just all this like
little scrub looking nurse oh,all of that's on the bag.
Speaker 1 (57:19):
Oh my goodness.
I thought that was a graphicyou put on there.
Oh my goodness very cool.
Speaker 2 (57:26):
The bags come like that, even the tissue paper
although there is tissue paperyou can find on amazon, because
you can find anything that'slike little different, like
little nursing things, I think acouple of the syringes and some
other stuff.
They're so cute though, butanyways, just wanted to give you
guys a couple of things,because I found so many.
But these bags here, notepads,spiral notebooks a little more
(57:48):
of an investment here, but Ijust think they're so cute.
They can keep those.
They're in school or somethingnursing school.
They can use that for whatever,but I just wanted to share
these with you.
You guys can go to the storeright here at the left-hand side
, bottom, and you click andit'll go straight to May and
you'll see all of the Maygiveaways.
Again, this is just designed soyou don't have to do the
legwork.
Speaker 1 (58:07):
And just remember, you can find nurses in skilled
nursing facilities.
You can find them in assistedliving.
You can find them in homehealth.
You can find them.
There are nurses everywhere, somake sure you're celebrating
them this week, may 6th to the12th.
Speaker 2 (58:22):
Yeah, and here's some more cool stuff Reusable straw
covers.
How cool are those?
Everyone has their stanley cupout and no germs, right?
I don't want anything flyinginto my drink.
So here we go.
They're really cute and they'revery nurse appropriate.
I love them.
And then there was just I foundthese really cute little nurse
lip balm, and they werespecifically designed for nurses
(58:43):
week, so I just thought I wouldlove this, lisa.
Speaker 1 (58:47):
Oh, you've done a great job in this.
I love it.
Speaker 2 (58:48):
Yeah, I just yeah, thought this would be cool.
All right, can't forgetcelebrating Mother's Day.
This one just very.
Celebrate Mother's Day and youcan take out a couple of
different things.
Here's some cute giveaways.
But call our text Valerie forall your home care needs.
But we've got some eye masks,these little steam masks, hand
and foot masks, just differentlittle things like that to take
out to your social workers andjust say you're celebrating
(59:09):
Mother's Day.
May leave behind Skin CancerAwareness Month.
John found these littlegiveaways actually last year and
I just wanted to bring themback because I just think
they're so cool.
But he doesn't want to bereminding people because, man,
some people I knew it was summerstarting because they were like
(59:29):
bright red lobsters.
One day it's starting.
Every year they get the samesunburn.
But this is really cool just toremind people to take care of
the skin.
You're in Easy to use skinhealthy UV monitoring and if you
go to the next screen you'llsee these.
You just stick them on your skinand they have all different
kinds.
They had dinosaurs, they hadyou name it but they start out
they're white and then they turnpurple once the UV rays are
(59:51):
getting too hot there.
But I just think this is reallycute, especially when you're at
communities where people arestarting to go out and they're
doing their luau's and they'reout in the sun and they haven't
been so much, so these arereally great to take out, maybe
cut up.
So this, your social worker ordirector of nursing is getting
all of the shapes there, butjust thought it was a cute idea
and wanted to bring it back thisyear.
Speaker 1 (01:00:13):
I actually handed these out in my last home care
agency, and so when it turnspurple, they know to apply
sunblock.
So these were a huge hit.
Everybody loved them and theyused them mostly for their kids,
I think, but it doesn't matterit was great.
Speaker 2 (01:00:26):
That's a really cute.
Some really cute differentideas too.
I think that's it.
Yeah, that is that's the lastone.
Speaker 1 (01:00:32):
Thank you everyone for coming.
This whole slide presentationwill be sent to you, so links
that we have on some of them theCanva and the Google docs links
all of that is here.
You can also probably I thinkthat, bill, you have a link on
yours as well Go back to Bill'sslide.
You can actually go into theslides and there you go.
(01:00:53):
He can take you right to hissite and all the information.
So you'll get the slide deckand then for the Amazon links,
you just go to the stores in thebottom of those slides.
Thanks everyone, we'll see you.
Thank you guys.
Have a great rest of your day,bye-bye, bye-bye.
Thank you, bye-bye.
This is going to be a fun, a good one, an informative
one.
These are the things I'vealways wanted to know, being in
home care almost my entirecareer long-term care.
We know we want those clients,we want them, we need them, but
we aren't always sure how tonavigate and how to get them.
So we have Bill here todaywho's going to help us with that
.
First, we're going to gothrough our housekeeping items.
(00:22):
Lisa, you want to be the one?
Yeah, for sure.
Okay, I'm not sure if Scott isgoing to be able to join us
today or not, so we'll go aheadand get started.
Speaker 2 (00:31):
And you guys already saw the chat, so if you have
anything to tell us, you canjust get in there and let us
know.
So lines muted unless you'respeaking.
Share stories, experiences,tips, ask questions, make
recommendations and tell us whatyou want to know for future.
Next slide oh hey, it's usReintroductions.
(00:53):
I guess I can start, since I'malready speaking, but I'm Lisa
Marcella.
I have been with ASN for twoyears now.
It's been a lot of fun.
It's really taken all of myexperience in home care as well
as back in the day withnewspaper and just shoved it all
into one.
So it's a very perfect placefor me to be.
Definitely, I love being a partof your guys' journey.
(01:15):
I can't stay in one lane inhome care, so this is just.
This is perfect and I lovebeing a part of it.
Thank you for letting me be apart.
Got off track there, but I'llgo ahead and give it over to
whoever's next.
Should it be Annette, you wantto go?
Speaker 3 (01:28):
Hi everybody.
I'm Annette Ziegler.
I know a lot of you here.
I have been in home care forover 20 years.
I teach the sales trainingclasses here with ASN.
I'm almost here a year.
I love what I do.
I love teaching you how to getthose private pay referrals grow
your agency.
Really glad you're here.
Very excited to have Bill here.
I told him I wish I knew himwhen I was in home care, so it's
(01:51):
going to be a great topic today.
Thanks for being here.
Speaker 1 (01:53):
Amen to that.
I feel the same way.
I'm Dawn Fiella.
I have been with ASN for closeto three years now.
I also have a background inhome care I like to say, in the
trenches of home care for closeto 20 years.
I've learned a lot along theway.
We've shared a lot of that withyou.
We share a lot of that with youhere in Mastery.
Thank you for joining us todayand allowing us to be a part of
(02:14):
your journey, and thank you forall you do with your seniors out
there and the care and supportyou're providing them.
I don't know if Valerie isgoing to join us today.
You're providing them.
I don't know if Valerie isgoing to join us today.
She is a co-owner and founderof Approved Senior Network.
She's a nurse by trait andshe's been doing this since 2008
.
We do a lot of websites andonline marketing and SEO, in
(02:35):
addition to the feet on theground training.
So we'll keep going, lisayou're up again.
Speaker 2 (02:40):
Okay, how to watch the meetings you missed.
What you're going to do is nextslide.
I'm not driving, so All right.
So you want to go log into theforum and did I miss a slide
there?
So home care marketing andsales support forum is right
here.
There you go.
Home care, home care salesforumcom.
(03:02):
There we go.
And your username is your emailaddress.
So whatever you signed up withus at the beginning with is your
.
That's your email address, andthen you should have got a
password sent off to that email.
If you don't remember it orjust can't find it, you just can
click on the forgot yourpassword option there, and this
little square is what it'll looklike when you get in there.
And then what you want to do isgo straight to where that arrow
(03:25):
is pointing.
It says learning.
If you go to the discussion, ofcourse you can go in there too
and you can talk to all of usyour colleagues, peers, all of
that, ask questions, get ideas.
But you want to go to thatlearning to get into the master
masteries, sorry.
And then, okay, there we go.
Cool, we changed the slide.
I forgot that we did, but thereyou see we have 2024 over there
(03:46):
.
But you want to go into that2025, click on there, open that
up and it will give you a listof different.
For example, here's January2025 and the two that we did
that month, and then as youscroll down you can see February
and on as we get them out.
All right, the mobile version.
So hopefully everyone'sdownloaded this already, but
it's Colab app and it's with aK-L-A-B how to use it and what
(04:11):
it's for.
So you'll get here.
It's called Lead Connector byold Colab, by Lead Connector,
and here is one for Apple.
So you can if you have Apple oryour Samsung, but it looks
pretty cool on your phone, youcan see here.
So there's a couple ofdifferent links.
Yes, yes, and boom, okay, soyou can go on.
(04:34):
So you see there's a wholebunch of different things going
on here.
But right here, the first thereis a where you can just click
on video so you can actuallywatch the replay.
You can also go to the nextslide over and you can actually
click on different links withinthe replay so you can go into
the leave behinds or anythingelse there.
I can't see the bottom of thescreen on my oh, okay.
Speaker 1 (04:59):
Down in the bottom, all of you see the circle blue.
Speaker 2 (05:03):
Yeah, now I can see it.
Yeah, it's kind of at thebottom there.
It's almost like all thedifferent pages, and so you have
the homepage of discussion andcircled right there is learning
and that's all you have to clickon and then you can get here.
So here you can see different,all the different features that
we have, so you can askquestions, you can see other
people's leave behinds or anyideas that they had, you know,
(05:25):
used and shared with us.
You can share anything on hereand you can ask any questions at
all and we usually get back toyou very quickly.
We also did something reallycool because we listened and we
put it to use, but we created ahomecaremarketingnewscom store.
So this store, we did thelegwork for you, no-transcript,
(06:11):
and now we're up.
Speaker 1 (06:13):
So we have Bill Comfort, csa, cltc, ltccp.
He's got lots of credentialingthere behind his name.
He is an independent long-termcare specialist at Comfort
Long-Term Care.
He is in Raleigh, durham,chapel Hill, North Carolina and
beyond.
34 years in the insurancebusiness, former radio and TV
(06:34):
journalist that's very cool.
His mission is to helpindividuals and families protect
against and financial costs oflong-term care disability.
He consults nationally withprivate duty home care industry,
educating care providers onlong-term care disability.
He consults nationally withprivate duty home care industry
educating care providers onlong-term care insurance claims,
and he's certified in all 50states.
So that's awesome.
We've got an agenda here.
(06:54):
Before we get started, though,we do one giveaway every meeting
of customized leave-behinds.
This time you will get Aprilleave-behinds.
If you would like for us totake all the April leave-behinds
.
This time you will get Aprilleave-behinds.
If you would like for us totake all the April leave-behinds
we're going to share with youlater, and put your phone number
, your logo, your colors on it.
We need you to type the wordyes in chat.
There is one little thing,though you have to promise to
(07:18):
take pictures and send them tous so we can share them with
everybody here at Mastery.
So please type the word yes ifyou want to be the winner.
There will be one winner forthe April Leave Behinds.
Type the word yes in chat andremember you have to take
pictures.
We will be tracking you downand that's going to start
tracking down those Februarypeople.
She's already got a list.
Okay, the agenda for long-termcare insurance.
(07:40):
This is a step you guys havealways wanted to know how do you
build strong relationships withlong-term care referral
partners to receive morelong-term care insurance clients
.
Learn the process foronboarding long-term care
insurance clients to home careservices, enabling faster claims
and stronger partnerships withreferral partners, and then
understand the different paymentstructures between long-term
(08:01):
care carriers and home careagencies, including direct
payments to the agency versusclient-paid models.
So Bill's going to go throughand cover all of this.
Please type your questions youhave for Bill in the chat and we
will make sure that they getanswered.
Welcome, bill.
We are thrilled.
I feel like I've waited 20years to hear this.
Speaker 4 (08:20):
We are thrilled to be here today.
Yeah, thank you.
I feel like I've waitedprobably 15 years to be a part
of this.
I actually, Valerie and Iworked together back in probably
2001.
There she is we're getting theband back together, Valerie.
Speaker 5 (08:38):
You know what I cannot believe.
It's been 25 years.
That is weird and crazy that wecould possibly be that old.
We were young sprites when wefirst met and we're all into
long-term care and stuff.
Speaker 4 (08:50):
And we're still in long-term care.
So I think that says somethingeither about our patient's
virtue, or maybe just stupidity,I'm not sure what.
Speaker 1 (09:02):
All right, bill, I'm going to be your driver, so just
tell me when you want the nextslide to come up.
And you're up there, you go.
Speaker 4 (09:10):
This is great and let me start by saying I wear two
hats in my professional life.
My main hat, my day job,depending on which day it is
selling long-term care insurance, engaging with clients, their
other advisors about planning inadvance for care and buying
(09:30):
long-term care insurance to helpfund that in whatever form, in
whatever way, and that's.
I've sold long-term careinsurance for more than 30 years
.
Valerie was part of helping tostart a specialty agency in St
Louis back in 2000.
So it's really all I've done inthe insurance business for the
last 25 years.
My other hat is as a continuingeducation instructor and I've
(09:56):
taught for the CLTC Certified inLong-T care program for 23
years now, which is really foragents and advisors planning for
care how to engage clients inthat advanced planning
conversation.
Obviously, long-term careinsurance is part of that.
(10:17):
But starting about 16, 17 yearsago I began doing private
consulting with the home careindustry.
In doing training aroundlong-term care insurance but
looking at it from the claimsperspective, particularly from
the view of a home care provider, years ago I started a
(10:41):
designation that I really justused for my private consulting
clients called LTCCP Long-TermCare Claims Professional.
It's an in-depth training inunderstanding long-term care
insurance from your viewpoint,what happens at time of claim?
(11:02):
What do you all need to do,what do you need to be aware of?
And we're going to touch on alot of those issues, at least in
an introductory way, today.
We're also going to share withyou how you can take the course.
We opened it back up, updatedit on the third edition of the
textbook last December, so it'snow available publicly and we've
(11:22):
got a discount for those of youin the ASN network.
That's my business and thereason this claims discussion is
so important.
Whatever level of clients eachof you have in your offices,
your agencies that havelong-term care insurance, over
(11:42):
the next 10 years, long-termcare insurance over the next 10
years, the number of people whoare going to need care with
long-term care insurance isgoing to significantly increase.
I don't know if it'll double,but it's going to be a
measurable increase lookingforward, particularly over the
(12:04):
next 10 years.
And the reason is becausethere's about 7 million give or
take people who have long-termcare insurance and half, a
little more than half, of thosethree and a half pushing 4
million policies pushing 4million policies were written
(12:31):
just in the 10 years between1995 and 2005.
Those were the largest salesyears for long-term care
insurance.
We peaked in 2002.
750,000 individuals bought apolicy just in 2002.
And let me give you acomparison Last year it was
about $150,000.
And that includes regularlong-term care insurance and
(12:54):
just life insurance with aspecific long-term care rider.
But here's the impact for youall today.
Think about a 60-year-old whobought her long-term care
insurance in 2002.
How old is she today?
She's 83.
(13:14):
What's the peak claim years 80to 85 is the very top of the
steep bell curve when long-termcare insurance claims begin.
75 to 85, you guys know theages of the folks that are
coming to you.
So we are going to see thesepolicies that were written 20 to
(13:38):
30 years ago.
Those are the policies that arecoming to claim today and it's
a bigger wave, a bigger cohortof older enforced policies than
we've ever seen in long-termcare insurance.
The carriers are scrambling tobe ready for this.
(13:59):
They're also pushing back insome ways, because this is where
the money starts going out thedoor for them as well.
So being savvy for your businessand in partnership with your
home care clients, I think isreally important and that's what
we're really going to focustoday on.
So go ahead Dawn.
So just to start, there's threelevels, so we're going to look
(14:24):
at each of these very generally.
But the first thing is tounderstand is your office, your
agency, even going to be acovered provider?
Questions around this.
(14:46):
We were talking before weopened the webinar today about
things like licensure and so on.
What I want to focus on is thismiddle point.
What does your client, yourhome care client, who owns a
long-term care policy, what doesher policy actually say?
Policy actually say?
Not on the schedule page,because most of them say home
(15:07):
health care, and I know you'renot home health care, but
long-term care insurance usesthat term very generically.
So the best advice that I cangive you and part of what this
LTCCP training does is reallydisassembles long-term care
(15:29):
insurance contracts to show youwhat to look for, where to look
for it, how to read thecontracts in detail, Because you
want to look and see what ishome health care generally and
how is a home health care agencydefined.
And there's a whole range ofdefinitions, particularly
(15:52):
policies that were issued in themid to late 1990s After about
2000,.
We have a lot morestandardization, but again we're
just beginning to get claimsfrom the most modern era where
there's more consistency acrosspolicies.
So this cohort this claims wavethat's coming has policies with
(16:14):
home care definitions that areall over the place.
A covered agency says you mustbe licensed by the state and
(16:35):
you're in a non-licensure statelike Arizona or Missouri, you
might not be a covered provider.
It's possible, but a lot ofpolicies have what's called an
alternative plan of careprovision where the client can
negotiate your client, thepolicyholder can negotiate for
(16:56):
an alternative payer.
And the problem is Valerie thisis going back probably 15 years
, but CNA was notorious back inthe 1990s for policies that said
have to be home health carelicensed to bill Medicare?
Basically there were like twohome health agencies that had
(17:25):
the proper licensure, that wereeven willing to staff, willing
and able to staff custodial care, private duty shifts for three
or four or eight hours a day.
Carriers have gotten better.
Cna has moved away from beingso strict on this and so that
kind of is an alternatenegotiation, but it's a
(17:48):
negotiation and the carriercould say no, probably the most
common language.
And this is where you need tobe very savvy.
Don't just take your client'sword, the policyholder's word of
what they heard the insurancecompany say to them.
(18:09):
Get with your client and sitthat either get a copy or sit
down with them at their kitchentable and look at their actual
policy, like the 40 or 50 pagepolicy, and find the page that
defines a home healthcare agency, and the language that I think
(18:34):
you're going to see that's themost common is it says you have
to be licensed by the state iflicensure is required.
Now I've seen carriers thathave just loaned past that.
Look, what are they trying todo?
They're trying to at leastpostpone starting to pay for a
(18:56):
claim.
Maybe they'll end up paying forit six months a year down the
road or when the person goes toassisted living or skilled
nursing, but that saves theinsurance company money.
Look, I could be a happy cynicabout my own industry here.
If the definition says industry.
(19:20):
Here, if the definition saysmust be licensed if required by
the state, you need to have, ifyou're in a non-licensure state,
a system of reporting with somedocumentation to the insurance
company, to your client, to giveto the insurance company or you
provide directly to theinsurance company as part of the
process that validates this.
And an idea that I got way backin the early 2000s back in St
(19:47):
Louis was a local agency inMissouri wasn't licensed because
it wasn't required.
And what this owner did waswrote to the state it's probably
Department of Health and HumanServices that licenses the
skilled home health agencies,the Medicare agencies right
(20:08):
Wrote to them and said do I?
Basically said do I need tohave a license to do private
duty custodial home care inMissouri?
I'd like a letter explainingthis.
And he got a letter back thatsaid in Missouri licensure is
(20:28):
not required.
And he kept a copy of thisletter and it didn't matter what
the definition said, every homecare claim, every client he had
with long-term care insuranceexcuse me, he would send a copy
of that letter in so you mightexplore that option.
Your state dawned like inArizona as we were talking
(20:50):
before we started.
Some policies say you have to belicensed if it's required by
the state.
If not, there's then a list ofcriteria and almost every time
I've seen the list, your agencyis going to meet that criteria,
(21:11):
especially if you have a nurseon staff to be able to supervise
, to write plans of care, dotraining, those kinds of things
which most offices do.
If you don't have an RN onstaff or on contract that you
can show, that's a little tough,but in my experience most
(21:32):
agencies are going to have that,where the one kind of
organization of how you'restructured where there could be
an issue is if you're truly aregistry where your providers,
your caregivers, are 1099employees.
(21:53):
That could be an issue becauseyou are not an organized
professional agency.
The only exception would beFlorida, and Florida has very
unique, specific laws relatingto long term care insurance.
It's not in the contracts butbasically behind the scenes.
The insurance law says inFlorida a registry must be
(22:17):
considered the same as a formal,organized home care agency.
That's of course irritating ifyou are a formal agency with
employed caregivers because theregistries maybe end up being
more competitive.
But we're looking from adifferent angle.
So obviously you have to livewith your state requirements for
(22:40):
your business.
North Carolina has a licensurefor private duty custodial home
care, so that covers a multitudeof different definitions,
because some policies just sayyou must be licensed by your
state definitions.
Because some policies just sayyou must be licensed by your
state.
Where we see the problems againis you have to be licensed as
(23:04):
home health care, skilled care,some say to bill Medicare, or
certified by the JointCommission, which is effectively
the same thing.
That's what you want to lookout for.
I think more and more as we'reworking from kind of 95 policies
issued in the mid-1990s forward, most of you are going to be
(23:25):
able to navigate around thesedefinitions.
But you have to know what thedefinition is and sometimes
you've got to go to bat for yourclient, the policyholder, and
either help them say, or get onthe conference call and say to
the claims person we meet everypiece of the definition on page
(23:48):
14 of Mrs Jones' policy.
That's not, that's generallynot.
I had this come up recently.
We have a standard for how weevaluate it and I said to the
person I said I don't care whatyour standard procedure is.
This specific policy says thisand it should be covered.
(24:11):
We'll have to look at that.
I said get a supervisor on thephone right now, right, covered,
we'll have to look at that.
I said get a supervisor on thephone right now, right.
You know the drill, but that'ssometimes what you have to do.
Let me pause here, dawn, andsee if anybody has any questions
or kind of examples around usthat we ought to discuss before
we move on.
Speaker 1 (24:28):
I do have a question.
So there is Victoria takeslong-term care insurance.
However, they do not bill theLTC because oftentimes they
don't pay.
Do you have any tips?
We have to providedocumentation and 3D, adls et
cetera.
I know we would get moreclients if we build the company
directly.
Speaker 4 (24:48):
Yeah, let's go to the next slide, because that's
something we had talked about.
Let me address.
Leave this slide up.
Let me address the questiondirectly.
So what you're describing inthe direct billing or direct
payment from an insurancecompany, that's called
assignment of benefits and maybea lot of you probably heard
(25:10):
that term.
So assignment of benefitssimply means the policyholder,
your client, signs a form orwrites a letter that says,
instead of me, the policyholderreceiving the check each month,
I just want you to send it to myprovider directly.
(25:31):
Same things have to happen.
You have to still showcaregiving notes and invoices
and the insurance company has toreview and adjudicate all of
that month in and month out.
So assignment of benefits canbe tricky.
However, I never recommend thatyou take assignment of benefits
at the very start of a claim.
(25:51):
Are you even an eligibleprovider?
Has that been determined yet?
Is the policyholder evenbenefit eligible?
I've worked with home careagencies where they've gotten
two, three months into servicesand basically the person's not
even eligible to go on claim yet.
And the client crosses theirarms and says well, you agreed
(26:14):
to take the insurance, it's notmy problem, they're not paying
Now, you got to sue.
The client crosses their armsand says well, you agreed to
take the insurance, it's not myproblem, they're not paying.
Now you got to sue the client.
It's just a mess.
So this idea of acceptingassignment should only be done
after the claim started, thatyou and the client know they are
benefit eligible, approvedWe'll talk about that in a
(26:37):
moment that you're an approvedprovider and that elimination
period, that 60 or 90 daysthat's already run.
Basically, don't take anassignment of benefits until
your home care client hasalready received at least one,
(26:59):
if not two, checks from theinsurance company for your
services.
That's my bright line advice onthat.
It can, let's say, the carrier,six months in, does a review
and they dig through the notesand it doesn't appear that the
caregiver is providing any ADLsupport, for example, and they
(27:23):
pause the claim.
They say it doesn't look likeMrs Jones is eligible anymore.
So it's probably a mistake.
But there could be a month ortwo of delay.
Often they will go back and payin arrears, but you all know
you can't float a month or twomonths worth of invoices that
(27:43):
way without consistent paymentcoming into your business.
Look, it's a business practicedecision.
I'm hearing more and more homecare offices, agencies, say
we're not doing assignment ofbenefits anymore.
We work our butts off todocument everything properly for
(28:04):
long-term care insurance, tosend direct to the insurance
company the caregiving notes,the plan of care and the weekly
or monthly invoices so they cansee everything.
But our deal is with our client.
They pay us and we help theclaims go through, but the
(28:25):
client gets reimbursed.
By the way, that's howlong-term care insurance is
designed to work Back in the 90sand the policies we sell today.
They are not designed to payyou.
Speaker 1 (28:44):
And you could even use that with clients.
Speaker 4 (28:48):
Yeah, go ahead.
Speaker 1 (28:48):
I have a question about that.
So how long might the clientwait to be reimbursed by the
insurance company?
Because that's the next thingthey're going to ask Okay, I'm
paying you, when am I going toget paid If you're doing all the
things?
We're just sending the ADLs,we're sending the plan, we're
done all the check is all done.
How long will they be waitingto get payment?
Speaker 4 (29:09):
It's really a question when you're at the very
start of a claim.
They've never been on claimbefore they're starting the
claim.
Most claims 80% of alllong-term care insurance claims
start at home.
That's not surprising to any ofus.
So if they have a 90-dayelimination period, some people
(29:30):
call it a waiting period, butthat could be a misnomer or lead
to some misunderstanding.
The 90-day deductible periodwhich they chose at the time
they bought the policy could bea little shorter, could be a
little longer, but 90 days 100days is the most common that
you're going to see.
There's no benefit paid for 90days, whatever that period is.
(29:55):
But let's use 90 in the exampleand let's say during that 90
days the company is efficientlyprocessing and agreeing that
your client is benefit eligible,that you're an eligible
provider, that they're countingthe days and at the end of 90
(30:19):
days the client has been payingout of pocket because it's their
deductible period.
The elimination period is thedeductible in long-term care
insurance.
So most people think they'regoing to get a check on day 91.
I'm sure Most policies are whatare called reimbursement, so
(30:40):
they reimburse for expenses thathave already been approved and
paid.
First check you have to get tothe end of the fourth month,
(31:02):
with services billed and paid bythe client during the fourth
month.
At the end of the fourth monththose invoices go to the
insurance company.
They review them.
That takes a week or 10 days.
They put it into their paymentsystem, which maybe takes
another week or 10 days.
So what I tell people?
Best case scenario at the startof a claim where you have to
(31:26):
get through that eliminationperiod, they are not going to
see their first check for atleast five months.
Speaker 1 (31:32):
Okay, wow, we've got more questions.
Yep, Go ahead.
If requested by long-term carefor an assessment copy of a care
plan or any other documentation, how can we charge for the time
it takes us to do that start ofa claim and how much do you
suggest for one hour assessment?
Speaker 4 (31:51):
That's an interesting question and I'm going to give
you an opinion.
That's just my opinion.
I think there's an ethicalquestion here that you have to
sort out in your business andhow your business is organized.
Are onboarding a home careclient with long-term care
(32:13):
insurance?
You have a responsibility,bill's opinion, to do whatever
it takes from your role as thehome care provider to get to the
client and or the insurancecompany the information that's
needed for them to use thispayment source.
(32:35):
Most agencies don't bill forthat time.
Might it take some extra timeand effort?
Yes, but recognize this is alsoa client.
If you do it, they have extraresources, they have extra funds
.
A large agency I just wastalking to the owner large
(32:55):
agency in my area here and hehas a significant number of
long-term care insurance clients.
He said on average, the monthlybilling for his clients with
insurance versus just privatepay out of pocket versus just
(33:20):
private pay out of pocket, it's50% higher on average.
So I think it's worth it foryou to do that.
Now let me here's my caveat,and I think where the ethical
question is if you have a homecare agency and you provide
already like a separate caremanagement service that you bill
for on an hourly basis.
If that's part of your businessstructure, then maybe you tell
(33:47):
the person look, this takesextra time and this is going to
be a care management servicethat could take an extra hour or
two and you bill your hourlyrate.
But if you don't operate thatway, I would not charge an extra
fee.
I think it's part of the costof doing business and working
(34:08):
with long-term care insurance.
Bill's opinion.
Speaker 1 (34:12):
Okay.
Speaker 4 (34:12):
Interesting question.
Speaker 1 (34:14):
Yeah, We've got lots of questions.
I'm having issues with aninsurance company not noting if
elimination period is servicedays or calendar days.
Speaker 4 (34:24):
It's in the contract.
It's one of those things youhave to find, smoke out and
identify in the contract.
So let me give you an exampleGenworth, which is the largest
in-force company.
They've got a million twopolicies in force and again,
probably half or more of thosewere written between 95 and 2005
(34:47):
.
And those are coming to claimtoday.
They have policies with a zeroday home care elimination period
, meaning benefits start day one.
They have policies that have aservice day elimination period
and they have policies wherepeople chose what's called a
calendar day as a better option,a more liberal option, as a way
(35:10):
to count those days.
Those days you have to look inthe contract and in my world and
my advice to you don't evertrust what the insurance company
is telling you.
You've got to verify it.
In fact, I would not advice toyou, I would not onboard a
long-term care insurance clientif they will not let you see
(35:33):
their actual policy.
And I know sometimes that's atrust issue.
They're afraid if you see it'slike I'm going to show you my
bank statement or something,you're afraid you're going to
overcharge them and use up theirpolicy too fast.
Look, you just got to overcomethat kind of trust and new
client engagement.
(35:54):
Maybe they'll give you a copyof it, maybe you again sit down
with them at the kitchen tableand you could even use some of
these issues as a way to explainwhy you need to do it together.
The way the elimination, the waythe 90 days are counted, mr and
Mrs Jones, we have to know thatfor home care, because in some
(36:19):
policies you have to hire usseven days a week that's service
days to get 90 days in threemonths.
Your policy might just requireus only to be here one day a
week and we need to worktogether on this.
And I got to tell you theperson on the other end of the
800 number, john, excuse me,genworth administers today in
(36:45):
their claims department, whichis in-house, they administer
close to a thousand differentcontract forms issued by
Genworth, ge, amex.
They also manage the TravelersBlock of Business and dozens of
(37:06):
other little companies that haveoutsourced claims to Genworth
as their TPA.
So that claims person, they'renot reading a specific contract,
they're working off a guidelinescreen.
Speaker 1 (37:19):
Right, okay, we've got some more.
After the waiting period,elimination period and claim is
approved, does the policyholderstop paying their LTC premiums?
Speaker 4 (37:29):
In most cases.
Yes, the term is called waiverof premium and most policies
waive the premium after theelimination period once benefits
become payable.
Some policies you got to goanother 30 days or 90 days after
(37:50):
the EP, but most commonly afterthat elimination period's run.
But most commonly after thatelimination period's run,
premiums are forgiven.
If a policy was issued in the1990s, anywhere in the 1990s you
want to look closely at thisWasn't common.
(38:14):
But some policies only waivethe premium if you're in a
facility, but they don't waiveit for home care.
So it's not universal.
But most policies I think thatyou run into will and, by the
way, that's a great thing to beable to show a client in their
policy if you're reviewing itwith them to help, particularly
if they're saying things like wedon't really want to start
using our policy now, we want tosave the benefits for later.
(38:38):
You hear that I'm hearing a lotof offices ask that question to
me and one of the reasons tostart a policy today is you get
to stop paying premiums and, bythe way, you don't have to use
the whole benefit.
You could choose.
If they have 6,000 a month andyou're only billing them 3,000,
(39:00):
they're only drawn down 3,000 amonth, for example.
Or let's say their policy is$6,000 a month and you're
billing $6,000 a month or more,they could choose to only submit
half the claims forreimbursement and it just it.
Generally, from a financialplanning standpoint I get it.
(39:21):
I get the emotion behind it,but from a financial planning
standpoint it makes no sense tonot use your policy and your
policy's benefits as soon aspossible.
But the waiver of premium oftengets people's attention.
So that was a great question,good.
Speaker 1 (39:38):
Great, that's all the questions we have.
We have a few more minutes, sogo ahead.
Please tell us more.
Speaker 4 (39:44):
Yeah.
So let me touch on what we haveon the screen here We've talked
about.
Are you a preferred provider?
Benefit eligibility is reallythe number one issue at time of
claim.
Nothing happens, theelimination period doesn't run,
days of your service aren'tcredited if they're not benefit
(40:06):
eligible, and that's the twophysical activities of daily
living or, separately,supervision for a cognitive
impairment.
Most policies and we don'treally have time to get into
sort of the 1990s versus what'scalled tax qualified policies,
(40:27):
which have some subtledifferences, but most policies
have two out of six activitiesof daily living Bathing,
dressing, transferring,toileting, eating and continence
are the six.
Speaker 1 (40:43):
But we have to be doing two of those for them to
qualify.
Speaker 4 (40:47):
But we have to be doing two of those.
For them to qualify, they haveto need assistance with two of
those correct.
Speaker 1 (40:52):
Okay, got it.
Speaker 4 (40:53):
Now this is critical.
It's probably the biggestmistake that I see being made in
home care agencies today whenit comes to claims eligibility
(41:15):
and that is not understandingand not properly recording in
the plan of care and notconsistently charting by the
caregiver whether the help ishands-on help or standby help.
Totally, most long-term careinsurance will approve a claim
or a loss of an ADL.
(41:36):
If it's simply standbyassistance, how do you know?
You have to read the contract.
Especially in the 1990s therewere policies that were hands-on
only.
But I think in the claimsyou're going to see today and
looking forward, the majorityare going to measure an ADL loss
(41:57):
on a standby basis.
You have to chart it.
I have three claims appeals I'min the middle of right now
where somebody been on claim fornine months a year and a half
in one case and the insurancecompany did a review and said
they're no longer benefiteligible.
They only need help with oneADL.
I reviewed four months the mostrecent four months of care
(42:19):
notes, daily care notes.
There was not one mention inthose care notes or check boxes
from the caregiver in the housethat they ever did any more than
one of the insurance ADLs.
Now they tried to tell me thatwell, they do transferring all
the time they drive her toappointments.
Transferring is not an ADL forlong-term care insurance.
(42:41):
You got to bathing, dressingtransferring.
Those are probably the threemost common.
Toileting is actually right upthere because of somebody's
mobility impaired.
This is interesting.
Most people don't know this.
It's new on my radar screen aswell.
The last few years of toiletingsays the ability to safely get
(43:07):
to and from and on and off thetoilet and obviously hygiene.
But if somebody needs helpgetting in and out of a chair or
a bed, which is transferring,they probably also need help
getting on and off the toilet.
There's two ADLs right thereand it says to and from.
If they're mobility impaired,they might be toileting impaired
(43:31):
and remember it's probablystandby assist and it has to be
both in the written plan of careand it's got to be reflected
consistently in the caregiver'snotes, however those are charted
or reported.
Speaker 1 (43:49):
You're so right, bill .
We had a couple of claims thatwe had to fight.
Also, you guys have to reallywatch what the caregivers are
charting.
If you have an LTC client, thatyou need to have them stand out
somehow.
If there's a new caregiver forthree days or something, they
have to be alerted to do this.
You've got to check over andover because it is not worth
(44:10):
having to figure out later.
Speaker 4 (44:12):
It is a nightmare.
Let's change the slide here.
I want to make sure we coversome of the things or that.
So yeah, just to that lastpoint.
There is a training issue herewith the caregivers.
I had a person share in theLTCP class last week that the
(44:35):
business manager of the agency,if they have a long-term care
insurance client, every carenote is reviewed in detail
before it's sent to theinsurance company.
And if they know there's two orthree ADLs on at least a
standby basis and they're seeingthat one of them's not being
(44:58):
charted, they will go back andwork with the caregiver to amend
those notes before they go tothe insurance company.
Speaker 2 (45:05):
Absolutely.
Speaker 4 (45:07):
Very valuable.
I want to talk a little bitit's really this screen and the
next screen about some ways youcan use your knowledge your
expertise, if you feel like youhave it with long-term care
insurance for marketing and goon to the next screen now, and
(45:28):
these are some different groupsobviously you can network with,
but I want to focus specificallyon financial advisors and
insurance agents as potentialreferrers to you.
You want to reach out to thesegroups.
Want to reach out to thesegroups not just asking for them
(45:51):
to refer their long-term careinsurance clients, who need care
, to you, but insurance agentsand financial planners.
They're going to have clientsin their 70s and 80s that don't
have long-term care insurancebut who need care.
How about if you're thatfinancial planner's go-to
resource about all thingsknowledgeable about home care?
(46:12):
See, you're going to getreferrals for private pay
out-of-pocket clients from them,but they are also going to know
when they have clients withlong-term care insurance.
So you're covering both bases.
And let me give you two ideas.
Insurance agents have a nationalassociation that many of them
(46:36):
belong to called NAIFA N-A-I-F-A, and it stands for Insurance
and Financial Advisors.
Whatever NAIFA N-A-I-F-A youcan Google it.
Google NAIFA Scottsdale I'llbet there's a local chapter in
the Phoenix, scottsdale orwherever you are, and they have
monthly or quarterly meetings.
(46:57):
They often will welcome a guest.
Just go and network and havecoffee.
They're always looking forspeakers.
If you did a 25-minutepresentation on the difference
between home health care andhome care and what pays for what
and what doesn't, you'll blowtheir minds and you'll get their
(47:20):
attention and you'll buildthose relationships as
relationships.
Speaker 1 (47:27):
That's a great idea, and we have a lead behind guys.
Speaker 4 (47:29):
That's the differences between non-medical
and medical home care.
I'm telling you a 20 or 25minute presentation at one of
these meetings.
It would really resonate.
So the other organization Iwant to share with you is FPA.
Stands for financial planningassociation.
That's what CFPs, CertifiedFinancial Planners, belong to.
(47:51):
Pa is more financial advisor,financial planner oriented, but
I mention it because they alsohave local chapters with regular
meetings all over the country.
They welcome visitors like youall as well.
Speaker 1 (48:11):
And Annette's put those in the chat.
Guys, the links are there foryou in the chat so you can copy
and copy them.
Speaker 4 (48:17):
So I think go one more slide here.
This is the shameless plugslide from your presenter today.
What we've done is in our 40minutes or 45 minutes here is
just scratch the surface.
You've gotten the key ideas ofthings to look for.
This is the course I developed10 years ago and that we've
(48:38):
recently relaunched Long-TermCare Claims Professional.
If you sit through a live Zoomclass it's five hours.
You're probably going to spendanother couple hours with the
textbook and the online reviewquizzes before you take the exam
.
We're going to have onlinerecorded videos that you can
(49:00):
self-study from.
They should be open andavailable in the next week or
two for this.
It's a 140-page textbook that'sfull of tips, not just
definitions, not just how thepolicy works, but what do you
have to do as a home careprovider, especially regarding
(49:22):
these different definitions,problematic definitions or the
plan of care, and examples wherethere can be issues and so on.
So that's all part of thiscourse.
You can see the website thereltccpcom.
There's a lot more informationthere and I'm extending a
discount to everyone in the ASNnetwork for 150 off the regular
(49:43):
tuition.
You can see the coupon code and, dawn, you're welcome to share
this with everyone in yournetwork and if you have a
question, if you go to thewebsite, hit the contact form.
I'm glad to connect with youthat way as well.
It is pre-approved forcertified senior advisor and
(50:06):
certified case manager.
Renewal CE credits.
Cmc what is it?
Care manager certified thoseare pending, hoping any day to
have those Again.
If you or someone in youroffice would benefit from the
course and they hold any ofthose designations, they can get
(50:28):
some renewal credits for theirdesignation.
Speaker 1 (50:31):
Thank you, bill, so much for that information.
It was really helpful.
Thanks for being here with us,too, today.
I think we might go to the May.
You good doing the May leavebehinds Lisa, yeah, hey guys.
Speaker 5 (50:48):
Yes, hey, can I say I'd like to say something on
behalf of Bill or about beforewe go on to the.
I know we're going to talkabout leave behinds and that's
awesome.
I will say this as a registerednurse, I have played all of
these roles, so I have been theperson that goes out and
certifies that they areavailable to go on claim, or
(51:09):
they should go on claim, thatthey meet all the criteria.
I've done that.
I've gone to houses and saidyes, filled out all the
paperwork.
There's certain organizationsthat hire nurses to go out and
do that sometimes.
I've also been the long-termcare insurance agent, which is
today weird because I still getnotices of my clients who have
not gone on claim yet and theymust be 100 years old by now.
(51:31):
And then I also have known Bill, like we said in the beginning,
for 25 years, and he isprobably one of the most trusted
folks in long-term careinsurance across the United
States.
There is no doubt in my mindthat we've been waiting for
something like this for a verylong time a class that home care
(51:53):
agency owners or their businessmanagers in their office or
their administrators or somebodycan take and then implement and
market the fact that they'reexperts in long-term care
insurance claims To be able tosay that have the certification
(52:15):
behind your name or yourorganization's name, and that
opens up a lot more of thislong-term care insurance
business and you won't be afraidof not getting paid.
You'll know exactly what to sayand what to do in all these
different little nuanced issuesthat come up with these things
and I'm not saying anybody'safraid to do it, but different
little nuanced issues that comeup with these things, and I'm
not saying anybody's afraid todo it, but you don't.
Once you go through the class,you don't risk not being not
(52:36):
understanding a policy and youalso open yourself up to having
lots of resources, because I'msure, along with the class, you
do have lots of folks you couldtalk to or send an email to and
say, hey, we're having troublewith this.
What's your recommendation?
We don't have guest speakersvery often, but we wanted to
have Bill on because this issomething that I feel like is
(52:58):
very important for home careagencies to know and understand
to increase their revenue andtheir bottom line.
So I hope that this was helpfulto everybody and I hope you
consider that his class might bea really good addition to your
accounting team, to you, towhoever your salesperson is out
there, whoever is opening upcases, and add it to your
(53:20):
marketing materials.
Don't just say we acceptlong-term care insurance as a
one line bullet.
We've got a lot of clients whomake a very big deal about how
they work with long-term careinsurance on their website, and
you should do that too.
It eases the mind of the adultchild who's looking for care to
know that you understand thisstuff, because it can be
(53:42):
complicated and they don't knowwhat they're looking at.
So anyway, good points, lovethat.
Speaker 4 (53:54):
Thank you, Valerie, and listen, thank you all for
your time and ASN for theopportunity here I will say just
continuing that discussionabout the class.
If you want multiple peoplefrom your office to take the
class, reach out to me because Icould do an additional discount
for addition for multiplepeople in the same office.
So, Valerie, thank you so much.
I that kind words and Iappreciate it.
It's taken us way too long toget to today, but I'm glad we're
(54:16):
here.
Speaker 1 (54:18):
That's awesome.
Speaker 5 (54:19):
Glad you're here.
Speaker 2 (54:20):
Okay, I'll leave you guys alone, so you can Okay, so
we should just skip to May ToMay.
Speaker 1 (54:28):
They're the new ones and we'll go through March and
April again next time.
Speaker 2 (54:31):
Okay, and then maybe, too, we might want to just
anyone who is interested ingetting the leave behinds, for
what are we doing for April.
If you would please, in the chat, just say yes, and if you're
interested in getting these are,it's all of them and we're
going to customize them and sendthem out to you.
(54:52):
So just yes in the chat and,okay, may leave behind.
So the idea behind this and I'mjust trying to go really fast
this is older Americans month isMay and so the I guess the
theme this year is flip thescript on aging and age how you
want to, and aging doesn't haveto mean stop doing what you want
(55:13):
to do or stop having fun, andso this is designed to, and it
has basically 20 ways to helpkeep seniors young at heart, and
it just gives differentexamples of things that they
could be doing.
And you want to take this outand just maybe this could become
a part of the move-in brochuresor any of that type of thing,
and this should be able to getsomeone the social worker,
(55:35):
director of nursing care, theexecutive director to come out
and talk to you, because youreally want to be able to
include this and this will helpthem to help their seniors help
figure out things to do withinthe community or other.
Just I'm trying to get it toyou as fast as I can.
Speaker 1 (55:51):
They also can like print.
You can give them a lot of themand they can give them out to
the adult children that they'reworking with for ideas for their
parents, too.
Right, I love this handout.
Speaker 2 (56:03):
Yeah, you helped me with it, thank you so much.
And you guys can go in with allof these.
You can go in and customizewith your logo, your information
, at the bottom of course, andthere's a link to canva and
google, uh, next up, and this isjust really.
I wanted you guys to be able tosee what these words are,
because I had to put a wholepage into 30, 30 font or
(56:25):
whatever, so you can just see 20, 20 ways.
Stay connected, join clubs,attend events, call family.
Number two is learn somethingnew, a language, a hobby,
something different.
Three stay active, walk daily,volunteer, laugh often, express
creativity and more.
Lots more.
(56:45):
Nurses week Don't forget nursesweek 6 to may 12.
I just want to say thank youfor them being all the
difference.
And then it gives a little bitof detail on how our caregivers
can help care for patientsneeding one-on-one support,
right, and then again you cancustomize any of these and we
have some cool little giveawaysto go with these too.
Yeah, they're in the giveaways.
So I was totally on justlooking all over the place.
(57:09):
I was so excited about this,but I love these bags.
I'm so excited to find thesebags and just all this like
little scrub looking nurse oh,all of that's on the bag.
Speaker 1 (57:19):
Oh my goodness.
I thought that was a graphicyou put on there.
Oh my goodness very cool.
Speaker 2 (57:26):
The bags come like that, even the tissue paper
although there is tissue paperyou can find on amazon, because
you can find anything that'slike little different, like
little nursing things, I think acouple of the syringes and some
other stuff.
They're so cute though, butanyways, just wanted to give you
guys a couple of things,because I found so many.
But these bags here, notepads,spiral notebooks a little more
(57:48):
of an investment here, but Ijust think they're so cute.
They can keep those.
They're in school or somethingnursing school.
They can use that for whatever,but I just wanted to share
these with you.
You guys can go to the storeright here at the left-hand side
, bottom, and you click andit'll go straight to May and
you'll see all of the Maygiveaways.
Again, this is just designed soyou don't have to do the
legwork.
Speaker 1 (58:07):
And just remember, you can find nurses in skilled
nursing facilities.
You can find them in assistedliving.
You can find them in homehealth.
You can find them.
There are nurses everywhere, somake sure you're celebrating
them this week, may 6th to the12th.
Speaker 2 (58:22):
Yeah, and here's some more cool stuff Reusable straw
covers.
How cool are those?
Everyone has their stanley cupout and no germs, right?
I don't want anything flyinginto my drink.
So here we go.
They're really cute and they'revery nurse appropriate.
I love them.
And then there was just I foundthese really cute little nurse
lip balm, and they werespecifically designed for nurses
(58:43):
week, so I just thought I wouldlove this, lisa.
Speaker 1 (58:47):
Oh, you've done a great job in this.
I love it.
Speaker 2 (58:48):
Yeah, I just yeah, thought this would be cool.
All right, can't forgetcelebrating Mother's Day.
This one just very.
Celebrate Mother's Day and youcan take out a couple of
different things.
Here's some cute giveaways.
But call our text Valerie forall your home care needs.
But we've got some eye masks,these little steam masks, hand
and foot masks, just differentlittle things like that to take
out to your social workers andjust say you're celebrating
(59:09):
Mother's Day.
May leave behind Skin CancerAwareness Month.
John found these littlegiveaways actually last year and
I just wanted to bring themback because I just think
they're so cool.
But he doesn't want to bereminding people because, man,
some people I knew it was summerstarting because they were like
(59:29):
bright red lobsters.
One day it's starting.
Every year they get the samesunburn.
But this is really cool just toremind people to take care of
the skin.
You're in Easy to use skinhealthy UV monitoring and if you
go to the next screen you'llsee these.
You just stick them on your skinand they have all different
kinds.
They had dinosaurs, they hadyou name it but they start out
they're white and then they turnpurple once the UV rays are
(59:51):
getting too hot there.
But I just think this is reallycute, especially when you're at
communities where people arestarting to go out and they're
doing their luau's and they'reout in the sun and they haven't
been so much, so these arereally great to take out, maybe
cut up.
So this, your social worker ordirector of nursing is getting
all of the shapes there, butjust thought it was a cute idea
and wanted to bring it back thisyear.
Speaker 1 (01:00:13):
I actually handed these out in my last home care
agency, and so when it turnspurple, they know to apply
sunblock.
So these were a huge hit.
Everybody loved them and theyused them mostly for their kids,
I think, but it doesn't matterit was great.
Speaker 2 (01:00:26):
That's a really cute.
Some really cute differentideas too.
I think that's it.
Yeah, that is that's the lastone.
Speaker 1 (01:00:32):
Thank you everyone for coming.
This whole slide presentationwill be sent to you, so links
that we have on some of them theCanva and the Google docs links
all of that is here.
You can also probably I thinkthat, bill, you have a link on
yours as well Go back to Bill'sslide.
You can actually go into theslides and there you go.
(01:00:53):
He can take you right to hissite and all the information.
So you'll get the slide deckand then for the Amazon links,
you just go to the stores in thebottom of those slides.
Thanks everyone, we'll see you.
Thank you guys.
Have a great rest of your day,bye-bye, bye-bye.
Thank you, bye-bye.
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