Our Services
We handle every stage of asking for more home care hours. Each stage builds on the last.
The first step is submitting a formal written request to your MLTC company, directed to your case manager.
What We Provide
- Personal intake to gather your medical conditions and ADLs
- Our team prepares your request letter
- Template request to your doctor for a Letter of Medical Necessity (LOMN)
- Secure document upload and management
- Guidance on what information to include
What Happens Next
The MLTC reviews your request, may initiate an assessment, and issues their determination. If they don't fully grant your request, you'll receive an Initial Adverse Determination (IAD).
Asking for more hours: The plan usually decides within 14 days, or within 72 hours if it's urgent. Sometimes it takes up to 14 days more.
If your MLTC issues an IAD, you have the right to file an Internal Appeal challenging their decision.
What We Provide
- Review and analysis of the IAD
- Internal appeal letter prepared by our team
- References to your LOMN and medical documentation
- Arguments built around your situation
- Document organization and submission guidance
What Happens Next
The MLTC reviews your appeal and either grants additional hours or issues a Final Adverse Determination (FAD). If they deny the appeal, you can escalate to a Fair Hearing.
Appealing to the plan: You have 60 days from the date on the notice to appeal. The plan usually decides within 30 days, or 72 hours if the appeal is rushed, though it can take up to 14 days more.
If your plan cut or stopped your hours, ask within 10 days to keep your current hours while you wait.
A Fair Hearing with the NYS Office of Temporary and Disability Assistance (OTDA) is the last step. This is an administrative hearing where you present evidence before a judge.
What We Provide
- Fair Hearing request filing with NYS OTDA
- Analysis of the MLTC's evidence package, including the UAS report
- Memo of law prepared by our team
- Identification of favorable data points in the UAS
- Complete evidence package preparation
What Happens Next
Both you and the MLTC present evidence. The judge reviews the case and issues a decision. The UAS report the MLTC uses to determine hours is often open to interpretation, and we identify the data that supports your request.
Fair hearing: You have 120 days from the plan's final decision to ask for a hearing. If the plan misses its own appeal deadline, you can go straight to a hearing.
White Glove Service. Coming soon.
Want to talk it over? Call (516) 212-4111.