Representing People With Denied Insurance Claims

Streamlining the appeal of a denied long-term care claim

| Jul 23, 2020 | Denied Insurance Claims, Insurance, Insurance Disputes

With the ever-rising costs of a nursing home stay, many in the Oklahoma City area are understanding that they may need such care in their old age and will purchase a long-term care insurance policy to help cover these costs when the time comes. However, sometimes a long-term care insurance claim is denied, which can lead to financial hardship.

What is important to know about your long-term care insurance claim?

It is important, first, to note that many long-term care insurance policies have a waiting period. This means the insurer will not pay for qualifying care for days or weeks after the qualifying care was received.

In addition, it is important to note that policies can change over time. The type of care that qualifies for a payout when you first purchase your long-term care insurance policy may no longer be covered when you eventually submit a claim.

Streamlining the appeals processes

One thing you can do when you purchase your long-term care policy is to have it reviewed by your adult children. After all, you may not have the capacity to deal with a denied claim when the time comes. If your adult children have a copy of your long-term care insurance policy and the insurer’s contact information, this can help when it comes to appealing a denial.

Long-term care insurance policies that were purchased after 1997 may only pay claims if the insured needs substantial help with at least two daily living activities or they are mentally impaired and can no longer handle their daily affairs. However, older policies may have additional requirements before they will pay a claim, such as being hospitalized for a certain amount of time. Knowing the terms of your policy can be crucial when it comes to appealing a denial.

In addition, sometimes physicians make mistakes when submitting information to your insurer which could lead to a denial of your claim. Insurers will want information not just on your diagnosis, but also evidence showing you need substantial assistance with your day-to-day life. If a claim has omissions, it may be denied.

Seek assistance when your claim is denied

Ultimately, you can fight a denied long-term insurance claim, but appeals can be complicated and trying to handle one on your own may not lead to a favorable result. Therefore, many people in the Oklahoma City whose long-term insurance claims have been denied will choose to work with professionals when appealing a denial.