The Overlooked Responsibility: The Administrative Side of Family Caregiving

When we hear the term "family caregiver," our minds often imagine compassionate individuals offering physical and emotional support to their elderly or ailing loved ones. While this captures a significant aspect of caregiving, there's an often-overlooked aspect that requires just as much attention – the administrative side. Family caregivers (also referred to as authorized representatives) are not only responsible for attending to their loved ones' physical health, but also for navigating the complex world of health care benefits. From dealing with billing issues to understanding insurance plan benefits, researching drug coverage, and arranging doctor’s appointments, caregivers shoulder a critical responsibility well beyond providing personal care. The administrative role they play is often taken for granted, but without their assistance, retirees may face significant negative consequences, ranging from missed appointments and overpayments to loss of coverage.

As older adults increasingly express their desire to "age at home," the responsibility on family caregivers increases exponentially. The transition resulting from this trend places additional demands on caregivers, with studies from the National Institutes of Health revealing that 29% of family caregivers report adding or changing insurance, and 39% have handled other insurance issues. Taking responsibility for these tasks is challenging enough when an older adult is relatively healthy, requiring mostly routine and preventive care. Transitioning to a new insurance plan, facilitating care for a new diagnosis, or contending with administrative tasks following a medical emergency require additional time and introduce a new level of caregiver stress.

RetireeFirst, which specializes in managing retirees' health care benefits, has shed light on the extent of the administrative load faced by many family caregivers. Their data reveals that of the 450,000+ retiree calls handled through its Advocacy team in the first 8 months of 2023, 10% were placed by authorized representatives or caregivers handling affairs on behalf of a health plan member. Billing questions alone constituted 18% of caregivers' calls, highlighting the complexity of navigating health care billing and payment systems. Additionally, 15% of calls were related to health care benefit plan design, while 10% pertained to medical exceptions and appeals.

These data points underscore the need to address the benefits-related administrative challenges faced by family caregivers. As expected, though, that’s typically easier said than done. Caregivers often aren’t sure where to turn for help, may not have time to research available resources, or could feel that the responsibility ultimately lies with them. Reducing overwhelmed caregivers’ health insurance-related stress requires accountability and support from multiple entities and angles within the care ecosystem, but it is possible.

Recognizing the vital role played by family caregivers and the challenges they face, health care providers, insurance carriers, plan sponsors, and fellow family members can all take steps to simplify certain tasks and ease the overall burden.

Although they act on behalf of another, caregivers must be recognized by health care providers and insurance companies as part of the care-delivery process. By acknowledging their role and communicating clearly, providers can equip caregivers with the knowledge and guidance needed to effectively navigate benefits as they pertain to a patient’s medical history and care plan.

Insurance carrier representatives can exhibit patience and kindness when working with a retiree’s caregiver, understanding the situation and certain information may be new to them. Health care systems and insurance companies may even take caregivers’ experiences and perspectives into account when calculating quality measurements. By incorporating their feedback, organizations can better understand the challenges faced by caregivers and work toward improving the overall care experience, leading to less stress for caregivers and healthier outcomes for members.

Plan sponsors, insurance companies and providers can also leverage technology to streamline family caregivers’ administrative responsibilities. User-friendly online portals, mobile applications, and digital tools can simplify tasks such as managing insurance claims, accessing medical records, and scheduling appointments. Even seniors themselves have demonstrated a shifting preference for technology. A survey of over 500 group health plan members conducted by RetireeFirst found that 45% of respondents use a computer to manage their health insurance, while 23% use a smartphone app and 13% use a tablet app. Caregivers are often more appreciative of those same convenient options, as they’re typically younger and tend to rely more on technology.

Plan sponsors can also offer caregiver training courses and care concierge benefits, a program that connects caregivers to service providers and resources nearby, reducing the stress and time demands experienced by caregivers. Educational initiatives that consider the unique needs and challenges faced by family caregivers can be tailored to offer specific support and guidance, ensuring a more holistic approach to caregiving.

Family caregivers are essential in supporting the health and well-being of their loved ones. However, sources that offer caregivers that same kind of support in return are equally as important. When caregivers receive support in managing their benefits workload, the entire system benefits. Easily accessible information reduces the need for caregivers to seek clarification from plan sponsors, carriers, and providers, saving time and energy for everyone involved and promoting overall satisfaction. Improved communication and care lead to better outcomes for members, which, ultimately, is the goal of caregiving.

About the Author 

David Zawrotny, Chief Service Officer at RetireeFirst, leads the company’s team of in-house Advocates who educate members on health care plan benefits, resolve issues related to drug coverage, billing, and more, and engage members in carrier-sponsored programs that enhance retiree wellness and close gaps in care. Prior to RetireeFirst, he worked with multiple Fortune 500 companies, including DuPont, Bristol-Myers Squibb, and Fortune Brands in strategy, health care benefits, and development. David graduated with Cum Laude honors from Franklin and Marshall College and obtained his Master of Business Administration from the University of Michigan.