Aging individuals who want to stay in their own homes for as long as possible are often able to do so through helpful Medicaid benefits that cover home care. Non-medical home care helpers, or companion care providers, assist with activities of daily living, which brings peace of mind to participants and their families. Elderly people who continue living at home still tend to feel independent even with this kind of support. Families worry less about their loved one when they know a competent helper is on hand to maintain a safe living environment.
Sometimes, participants in home care and their families feel they need more care hours than their insurance currently covers. In these cases, they can request an increase, and the insurance company will make a determination. Since the coverage must be requested, there are a few tips that will help the participant be successful in getting approved.
Assessment for Increased Home Care Hours
Keeping up with routine well checks is not only important to a participant’s general health, but it could also help them obtain an increase in care hours. Primary care providers keep the best records and health history when patients make regular visits and share specialist summaries with them. Insurance companies often review these records or request input from doctors to determine if an increase in home care hours should be approved. Participants who haven’t seen their doctor in a while should schedule a visit before requesting additional hours of care.
To request an increase in home care hours, participants first need to contact their insurance company’s Service Coordinator. The Service Coordinator will help the participant complete a request for personal assistance services. The participant may need to answer a few questions about their health and their needs so that the insurance company can make a proper assessment. Again, comprehensive medical records will offer the most complete picture of the participant’s current level of need.
When Increased Home Care Hours are Denied
Sometimes, participants will receive a denial letter from the insurance company. While this is discouraging, it may not be the final decision. Participants have a few options upon receipt of a denial for increased home care hours:
- Call the insurance company or write a letter to request the medical necessity guidelines used in the decision. This is available to participants at no
- If the participant’s doctor assessment does not support the increase in home care hours, the participant can request a second opinion from another provider in the
- The participant can file a complaint or grievance by phone, online form, or
The insurance company will send a new decision within 30 days, or faster if the participant’s doctor submits a letter requesting an early decision for health reasons. Many participants can get approved for more home care hours after this appeal. While it is frustrating and time consuming, it is often worth the final result.
Caring for Participants with Empathy
Linda’s Care was founded on the principle of caring for people as though they are family. We understand the frustration that participants and their families experience when they need increased home care hours, but are not getting approved for the additional time. We support our participants and their families by offering resources and suggestions that help them reach a positive outcome in their request for increased hours. If you are looking for qualified home care services in Philadelphia or the surrounding counties, contact us to see how Linda’s Care can help. We can answer questions and schedule a consultation to match you with a caring home care