[Critique Group 1] Leonard's comments on Cleora's sub

[Leonard Tuchyner]

Cleora sub April 23

 

 

You use too many anachlonymns  or initialisms. 

I don’tk know what they mean. 

Too much technical information. 

It was like reading a legal brief. 

The basic ideas came across, 

and were  useful. 

If I ever need help on choosing  an agency, 

I’ll call on you. 

You  obviously have alot of experience. 

What   a  about size of agency? 

Some of your examples were too intgricate to follow. 

Potentially, very useful, though. 

The spell/grammar check came up with a lot of  problems.

 

1000 words

Help Still Needed

by C. S. Boyd

 

A while back I wrote a guideline intended to help readersselect a good Home Care agency. Things are changing rapidly, and it is moredifficult than ever to find a good agency with qualified caring people.

 

1. It still holds true to check the required experience.Since you will be a new client, you will most likely be sent a new hire. Youmay even be their first assignment. Past experience is important. If this isthe person's first time to work as a caregiver, may likely have no idea whatthe job is really like. Many never stay past the first two weeks. You wantsomeone who will provide the help you need, and will stay so you can a developa relationship;.

It is also still important to let the agency knowspecifically the kind of help you need. If your care includes tasks that arenot part of the run of the mill home care--you need help with reading mail,completing and submitting form, etc.--the agency may not have anyone on staffthat can do this. Or, they may not be willing for their caregivers to have thiskind of responsibility.

 

2. Does the agency file Long Term Care claims. If you arehoping to pay for services with LTC, ask if the agency charges for filing theclaim, and if they are willing to wait until you receive your reimbursement.

 

If they charge for filing the claim:

 

If the charge is a flat fee, this charge will be out ofpocket. As far as I know, no LTC insurance pays fees. If they add $1 to thehourly rate, and you have a limit on your benefits, this will reduce your careby that amount. 

 

Example: if you have a caregiver 40 hours a week, this willreduce your benefits by $20,800 per year.

 

One hundred percent of the agencies I talked to said notgetting paid was the reason they started charging to file and requiring paymentimmediately. My experience with the ones I tried indicates that you will have ahard time getting your reimbursement. These agencies chronically do not filethe claim with all the necessary information required for it to be paid. Thismeans you will spend your time finding out what was done wrong and trying toget the agency to refile the claim correctly. It took me two and one-halfmonths to get my reimbursement for one service day. The problem was that thecaregiver didn't mark that she did the ADLs, and the agency claimed theycouldn't fix it. They continued to file the claim with the same error over andover. They put a note on the claim saying the ADLs were done and for theadjuster to call them, the insurance said they didn't have time to call andwanted the agency to call them instead. The agency said they didn't have timeto call the insurance and most insurance would accept the note on the claim asproof. Mine does not. So I have this back and forth. My insurance said that ifthe agency calls and says the ADLs were done and they do not have access tocorrect the claim, they would pay it. I spent countless hours on the phone withthe insurance company and with the agency trying to get this taken care of. Canyou imagine paying extra for this headache?

 

I did finally get my reimbursement. I realized that I hadaccess to the visit notes that the caregiver completed. I went into theirsystem, copied the visit notes for the day in question, created a copy in Word,edited out the error, created a PDF and submitted it with a copy of theoriginal invoice. The insurance accepted it and paid the claim. I moved on toanother agency before I had to test this option again. I will also mention thatthis is the only agency I have used where I had this kind of access.

 

Keep in mind that if the agency requires you to pay upfront for the service, there is no incentive on their part to help you get yourmoney. One agency I talked to wanted payment as soon as the shift ended. Theywanted to be able to make an ACH withdrawal or charge my credit/debit cardimmediately after the caregiver clocked out. I probably don’t need to tell youI didn’t sign with this agency.

 

3. How long has the agency been in business. I recommendlooking for agencies that have been in business at least 10 years. This givesthem the time to become experienced in selecting good caregivers and matchingthem with the right client. It is also important if you have LTC insurance. Youwant someone experienced in how to file the claims correctly. If they arewilling to wait for you to be reimbursed to get their payment, it is a goodindication that you will not have trouble getting your money.

 

4. What is their afterhours contact? If it is an answeringservice, mark them off your list and try the next one. Ideally you should beable to call the regular daytime number and reach someone from the office thatis on call. If you get voice mail, leave a message. If it takes them more than30 minutes to call you back, mark them off your list and move on to the nextprospect. 

 

There have been a couple of times over the last 20 plusyears that it was vital for me to reach someone after hours. When shopping fora new agency, I deliberately call after 5:00pm or on the weekend to see howhard it is to reach someone in an emergency. If the owner answers, they willusually go ahead and talk to me about their service, but it's not a problem tocall back when they are in the office.

 




 
 
Leonard I. Tuchyner, Author
 
https://www.dldbooks.com/tuchyner/

 
  
 
 

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