How Insurance Approves or Denies Care Hours

Insurance plans and Medicaid programs approve care hours based on clinical assessments, documentation from providers, and program criteria. Factors may include your ability to perform daily activities independently, medical conditions, safety risks, and available caregiver support at home.

Sometimes, requested hours are partially approved or denied. In these cases, you may have the right to appeal. Regency can explain the decision and help you understand the appeals process.

If your needs change over time, see “How to Request More or Fewer Care Hours.”