The Care Manager Sells a Scope: Compare the Fee Method, the Referral Ties, and the Written Duties Before You Sign

A private care manager, often called a geriatric care manager, assesses the situation, schedules providers, sits in on family meetings, and keeps track of appointments and paperwork. That is useful work for a household that has more calls than hours. It is not medical care, it is not legal advice, and it is not tax or benefits advice that replaces a licensed professional. A care manager who says otherwise is selling you something outside the scope of the job. Compare the offers on the paper they put in front of you, not on the sales conversation.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Start with the fee method

Care managers charge in several ways: an hourly rate, a flat fee for an initial assessment, a monthly retainer, or a combination. Ask which method applies to each task on your list. Then ask whether any part of the fee rises with the amount of care you buy. A fee that grows as you purchase more hours from an agency puts the manager's income in a different place from your interest, and you should know that before you agree.

Ask about billing increments. Some managers bill in fifteen-minute blocks, which means a five-minute phone call may be billed as a full block. Ask whether travel time is billed, whether phone calls and email are billed, and whether a family meeting counts as one hour or as the full time of everyone who attends.

Ask about referral ties

Ask directly whether the manager receives any payment, discount, or other benefit from the agencies, facilities, or vendors they recommend. Ask for the answer in writing. A manager with referral income is not automatically a bad choice, but you need to know it, because the first list of agencies you receive will come from that person. Ask for at least two names of providers you are free to choose without going through the manager.

Check the credential, then check the source

Ask which professional credential the manager holds and which body issued it. Do not rely on the card in the folder. Look up the credential with the issuing body yourself, and confirm the name on the license matches the person sitting across from you. Credentials show training, not the quality of the person's work on your case, so treat them as one check among several.

Read the written scope

The scope should be a list of tasks, not a paragraph of goals. Look for these lines: who is contacted for each task, what the manager will do in a crisis call, how often the manager will report to the family, and what is excluded. Medicines stay with the family, the doctor, and the pharmacist. A care manager can help you schedule a prescription pickup or coordinate a visit, but sorting, dosing, and managing medicine are not part of the scope, and a contract that suggests otherwise should be corrected before you sign. Also read the cancellation terms, the notice period, and any charge for the work already done.

Compare the same list three ways

Write one task list and ask at least two other care managers to price that same list. Compare the totals for the same tasks, the billing increments, the travel rules, and the referral disclosures. If the proposals do not describe the same work, you are comparing marketing, not prices.

Where to get a free second opinion

Before you commit, ask the Missouri SHIP counseling program to help you separate what the manager is selling from what Medicare already covers. SHIP counselors give free help on Medicare questions and can point you to what is and is not covered, which keeps you from paying a manager to explain a benefit you already have. For any question that turns into a legal problem, such as a power of attorney or a dispute with a provider, the Missouri Bar's referral resources are the place to start, not the care manager. The Sources page lists where each of these agencies' rules come from, and the How We Write page explains how this desk handles its own claims.