Have you been denied a service or program for long-term care benefits?
You may qualify, but the source who denied you is giving you incorrect information or a half truth. The most common statement I hear from a potential client is they were told by someone they trust, like a professional or experienced friend, that they do not qualify.
How can you trust the advice or the source of your information? When it comes to healthcare, elder care, veterans and Medicaid benefits, the truth is always in the details and the exceptions.
For every rule, there is an exception to the rule. And for your situation, I promise there is always more to it: more options, more savings, more hope, than what you are being told.
Let’s look at some of the common denials my clients receive and TRANSLATE them into what they really mean:
“You do not qualify for VA healthcare.” Translation: “You don’t qualify for 100% free care. Unfortunately, you will have to pay an $8.00 deductible for your prescriptions, and you’ll have to pay for your own transportation to the doctor or hospital.”
“You do not qualify for VA Wartime Pension.” Translation: “You have to reorganize your financial assets and income in order to qualify for the VA benefit and we are not able to guide you on how to do that.”
“You have to spend-down in order to qualify for long-term care coverage through Medicaid.” Translation: “You can always keep one-half of your assets, maybe much more, and qualify for coverage but you will have to have professional help.”
“You can’t get placement until you are qualified.” Translation: “We want you to disclose your finances to us so that we know how to get the most money out of you before we accept you into our healthcare facility.”
Challenging Long-Term Care Insurance Denials
Policyholders can effectively challenge a long-term care insurance denial by first carefully reviewing their insurance policy to understand the covered services and any stipulated waiting periods.
It’s crucial to gather all relevant medical records and evidence that demonstrate the need for daily living assistance, whether in an assisted living facility, nursing home, or through an eligible care provider.
Engaging a law firm with experience in insurance disputes can also provide valuable guidance through the appeals process.
Many policyholders succeed in overturning denials by providing additional documentation that clarifies the extent of their care needs or by demonstrating that they have met the policy’s criteria, including paid premiums and eligibility requirements for receiving care in a private room or specialized facility.
Immediate Steps After Denial
Upon receiving a denial of long-term care benefits, policyholders should immediately request a detailed explanation from the insurance company. This explanation will highlight the reasons for the claim denial and inform the next steps.
Family members can assist in this process by helping to gather the necessary documents and evidence. It’s essential to act quickly to comply with the insurance policy’s deadlines for the appeals process. Submitting a comprehensive appeal, including detailed medical records and a letter from a healthcare provider attesting to the necessity of long-term care, can significantly enhance the chances of overturning the denial.
Additionally, policyholders should document all communications with the insurance company and consider seeking advice from a professional experienced in long-term care policies to navigate out-of-pocket costs and insurance appeals effectively.
I want you to be able to keep the largest amount of your money and property you possibly can AND get the best care you can. Translation: Where there is a will, there’s a way! We’ve helped so many people in Madison and the surrounding counties do just that.
Call us today at (859) 544-6012 to get your Free Guide to Qualifying for the Care You Deserve. Visit www.elderlawguidance.com for additional information.
