I have been a LVN for 15 years and have decided to open a small residential elder care home. Until I'm licensed, will a resident's LTC insurance cover the cost?

SWhitley, I'm looking for private duty firms, and in the process ask for a copy of the contract before I go much farther. One has a provision for dealing with insurance policies. I'm P'M'ing you some information on this. (Check your messages in about 10 minutes or so.)

Also would like to add, my moms NH would NOT accept any LTC insurance as a payor. Sign even posted that facility was Medicare, Medicaid or private pay only. I asked the billing guy why, and he told me that for those who had LTC polices that would pay facility directly it was just way too too time consuming to deal with. That the insurer always always always had another form or document needed. And that often it was about staffing levels and staff education / certification so lots of exact time & scheduling info needed to be sent. Often older LTC insurance done as how medical care was done back in 1970’s - 1980’s with wording in the policy requiring care to be done by an RN or maybe a LVN, (& at 1970/80’s pay rates for even more fun) so care nowadays by an “aide” or even a PA (physicians assistant) cannot meet policy requirements. Insurer will not pay.

For moms NH dealing with any LTC insurer not worth it as they could easily fill beds with Medicare or Medicaid & get paid in real time. You might want to visit a couple of IL & AL under the guise of “ needing a place for your Aunt” & get a copy of the admissions agreement to see how payment terms are done. Like 60-70% of elderly in a facility are Medicaid eligible, so they are basically judgement proof if they end up not paying you. You can’t afford to let a new business become a charity.

MsMadge, your experience with GW is common. They are stickler for precise details. Almost all polices have a initial window of time (90 days usually) in which LTC won’t pay or even start to process claim till that window is over. The delay migh have been due to this. Some exclude rehab stays from the 90 day countdown too as their not a long term resident but in rehab. Btw GW is probably being sold to Chinese invesment group.

Basically If an insurer can limit exposure (whether its paying a LTC policy or paying on homeowners / flood / wind policy from a disaster), they will.

I work in the legal department of an insurer that offers a LTC rider on life products. I review LTC claims. Unfortunately, until your facility is licensed, we would not issue a benefit to our insured (or if assigned, to the facility), even if the rest of the claim is in good order. Our riders all require the facility have appropriate licensure before a claim is considered in good order.

The two different insurance agencies I dealt with were very clear..only licensed, certified agencies were eligible. The insured paid the bills first and then the insurance company reimbursed.

Get the license and the state certification.

Thank you! That has been my understanding as well. I understand the LTC insurance is sent to the resident not the facility. Thanks for the help!!

Mom has Genworth LTC - I had to jump through hoops to get her claim started with the move to memory care

It seemed it was bogged down just so folks would give up filing a claim - it took a lot for a claim to be filed in early February until acceptance in May

That said, once accepted there haven't been any problems

When I asked about payment for placement in a residential board and care they responded it would be unlikely so be sure to try and find out what their requirements might be

BTW
Payment comes directly to mom not to her facility so you would need to make sure your clients can self pay before you accept them

Thank you for the help!

If you are thinking that LTC insurance will be a payment stream for your new business, I’d suggest that you do whatever licenses / certification / eligibility needed in order to pass review to be listed as a provider on CareScout. CareScout is a LTC provider listing within Genworth. Genworth is IMO the market leader for LTC insurance in the US; their well managed.

I’m not personally a fan of buying LTC insurance; don’t have it. But if I had to pick a LTC insurance co that is solid, it would be Genworth.

Best of luck in your venture. Small board & care homes are hard to find.