It’s really a big problem that when the agencies, registries and insured people are calling the insurers for insurance verification, insurance information, coverage issues, when the insurer says no, they accept it. It’s such a huge problem because there’s an inherent conflict of interest where the insurer is the entity paying and also being asked advice about whether they should be paying.
I like to believe that people always do the right thing for the right reasons but when there’s a conflict of interest you have to have a third eye looking at everything to make sure that people are doing what they’re supposed to be doing. I tell my registry and home health agency clients that as a practice, they should be getting copies of policies from their clients. And understand what the policy benefits are so that they can properly manage it so that they’re not hit at the end maybe with some letter or some denial by the insurer that policy is maxed out, we’re sorry you’re done.
People have to know if they’re reaching the end of coverage, what they need to do to restore properly and without having the policy in hand there’s no way possible they’re going to be able to manage it. Time and time and time again, in the cases that I’ve handled on behalf of registries and agencies, the controversy arises at the end of the claim period. Where there’s no information or not credible information flowing between the insurer and provider. The next thing you know the provider is saying you’ve reached the end and so forth. Then you have a big problem. You have catastrophic problem because the insured person is being told “your insurer says your benefits have expired” and nobody’s been able to plan for that, nobody’s been able to deal with that in advance.
To me, if the policy is the mechanism that is driving the care and the benefits, the caregivers should have the policy and understand it. I’ve told my registry and nursing agency clients that if they get the policies, I’ll be more than happy on their behalf and the insured’s behalf to look at it and give them just two or three lines about what certain triggers they have to look out for and how to properly plan and utilize the policy so that there is no catastrophic benefits.