Dealing with long term care insurance can be challenging, especially when your claims are denied. Fortunately, there are several ways to appeal a denial and receive the benefits you deserve. In this article, we’ll discuss the problem, provide solutions, share some success stories, and answer frequently asked questions about how to appeal long term care insurance denial.
The Problem: Denied Long Term Care Insurance Claims
Long term care insurance is designed to provide coverage for individuals who need assistance with activities of daily living such as bathing, dressing, and eating due to an illness, injury, or cognitive impairment. However, insurance companies may deny claims for a variety of reasons, such as lack of medical necessity, pre-existing conditions, or not meeting policy requirements.
The Solution: How to Appeal Long Term Care Insurance Denial
If your long term care insurance claim is denied, don’t give up hope. Here are some steps you can take to appeal the decision:
Before filing an appeal, review your policy to understand the coverage and benefits you’re entitled to receive. Make sure you understand the terms and conditions of your policy, as well as any limitations or exclusions.
Collect all the documentation you need to support your claim, such as medical records, doctor’s notes, and receipts for medical expenses. You may also want to obtain a second opinion from another healthcare provider.
File an Appeal
Contact your insurance company to file an appeal. Be sure to provide all the necessary information and documentation to support your claim. You may also want to consult with an attorney or a long term care insurance specialist to help you navigate the appeals process.
Be persistent in following up on your appeal. Keep track of all correspondence and phone calls, and document all your interactions with the insurance company.
If the appeals process proves unsuccessful, consider mediation as an alternative dispute resolution option. Mediation involves working with a neutral third party to resolve the dispute.
Seek Legal Advice
If all else fails, consult with an attorney who specializes in long term care insurance law. They can advise you on your legal rights and options for pursuing a lawsuit against your insurance company.
One woman was denied long term care insurance benefits after she was diagnosed with Alzheimer’s disease. Her insurance company claimed that her condition was a pre-existing condition and not covered under her policy. However, she filed an appeal and provided additional medical documentation to support her claim. After several months, her appeal was approved and she received the benefits she was entitled to.
Frequently Asked Questions
Q: What should I do if my long term care insurance claim is denied?
A: Review your policy, gather evidence, file an appeal, follow up, consider mediation, and seek legal advice if necessary.
Q: How long does the appeals process take?
A: The length of the appeals process varies depending on the insurance company and the complexity of the case. It can take anywhere from a few weeks to several months.
Q: Can I still receive long term care insurance benefits if I have a pre-existing condition?
A: It depends on your policy. Some policies may exclude coverage for pre-existing conditions, while others may provide limited coverage. Review your policy to understand your coverage.
Q: Do I need an attorney to file an appeal?
A: It’s not necessary to hire an attorney, but it can be helpful. An attorney can help you navigate the appeals process and provide legal advice.
Q: What is mediation?
A: Mediation is a process where a neutral third party works with both parties to resolve a dispute. It can be a less expensive and less time-consuming alternative to a lawsuit.
Q: How can I find a long term care insurance specialist or attorney?
A: Ask for referrals from friends, family, or healthcare providers. You can also contact your local bar association or state insurance department for a list of attorneys who specialize in long term care insurance law.
When filing an appeal, be sure to provide all the necessary information and documentation to support your claim. Keep track of all correspondence and phone calls, and document all your interactions with the insurance company. Be persistent in following up on your appeal, and consider seeking legal advice if necessary.
Dealing with long term care insurance denial can be frustrating, but it’s important to know that you have options. By knowing your policy, gathering evidence, filing an appeal, and seeking legal advice if necessary, you can increase your chances of receiving the benefits you’re entitled to.