Long-Term Care Insurance Claim



Long term care can be a very sensitive topic, with even more complications arising when discussing long-term care insurance. Whether you, or a loved one, is placed in a nursing home, an assisted living facility or is receiving in-house care, all can factor into your long term care insurance policy coverages. With so many varying factors throughout your long-term care insurance policy, there are several ways in which your insurance company could deny your long-term care insurance claim.

For example, although you may be approved for specific treatments and services, your claim may be denied because you are approved for a nursing home but the facility in question is technically referred to as an assisted living facility. Or vice versa. Simple semantics such as this are often the basis for health insurance claim denials. Minute details can make all the difference in the outcome of your health insurance claim.

Another detrimental claim denial comes from the basis that the policyholder is in fact no longer cognitively capable and the medical services being received are then in turn no longer necessary. These type of long term care insurance denials tend to be very fact and/or policy intensive. When it comes to these facts, sometimes the opinion of an expert is required.

The Difference Between an Assisted Living Facility and a Nursing Home

It is important to understand that your long-term care insurance policy may differentiate between a nursing home and an assisted living facility. There are many claim denials on the basis that one can receive long-term care from a nursing home but not an assisted living facility, even though they are really the same in the services they provide. The main difference is simply how the entities were incorporated in that state.

Although for all practical purposes they are nearly the same in that they provide care, the insurance companies will work against you with that technicality. If your policy provides coverage for an assisted living facility and you check into a nursing home, the insurance company will deny your claim.

These denials are common and can result in thousands of dollars having to come out of your pocket weekly or even daily. Be certain to check what kind of facility or home your policy affords coverage for to avoid this issue. Many policies will cover both now but this distinction still exists amongst older policies. Often these older policies belong to the people receiving care by these facilities today.

Ease the Billing Process

We are willing and able to work with not only the long-term care insurance policyholder but also those with assigned benefits on the long-term care insurance policy. The nursing home or the assisted living facility can work with Merlin Law Group to keep their client and have the insurance pay so you don’t have to kick out your client receiving care. Intake analysis is always free at Merlin Law Group and we would be happy to offer our services and answer any questions you may have.

Whether your long term care insurance claim is being denied on the basis of functional capacity, medical necessity, through misinterpreted policy language or more, the Merlin Law Group can help. The attorneys at the Merlin Law Group have the skill set and resources to adequately represent you. Not very type of policy or claim denial can be discussed, so if you have any questions, do not hesitate to call today, toll-free anywhere in the nation at 877-49-4700.

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