Your parents have been in a nursing home for years. You spent weeks shopping around for the perfect and found an ideal assisted living facility only a few minutes from your home. Your parents’ decades-old long-term health care insurance policy even covered the costs — at least, at first. Now, your parents tell you that their carrier denied their latest claim, footing you with the bill.
If an insurance company denies a long-term care claim, you can file an appeal with the company and the courts. When it comes to long-term care, this is often your best chance to secure continued coverage.
Denying claims protects profit margins
Few people purchase new long-term health insurance policies. Rising insurance premiums have made these plans too expensive for most. Policyholders are primarily older Americans facing retirement age who purchased the plans in 1980s or 90s. Now, as Boomers cash in on these plans, insurance companies fail to profit, leading many adjusters to deny claims.
Most long-term insurance denials cite outdated conditions and poorly worded legal terms. Many of these policies only cover services deemed “medically necessary” and will deny coverage for services that help with “activities of daily living.” The adjuster will send your parents a letter after denying coverage that should detail their reasons.
Seek medical advice and file an appeal
Before filing an appeal, you’ll want to check with your parents’ nursing home and doctors to review the original claim and the letter of denial. Double-check the following:
- The nursing home or senior care facility is eligible for the coverage
- The policy covers your parents’ medical needs
- You and your parents understand the reason for the denial
Sometimes, insurance companies deny claims based on faulty or incomplete data. These decades-old policies often contain language that refers to medical conditions, procedures or processes that no longer exist. Many policies cite obsolete qualifications or outdated professional requirements.
The best way to appeal a denied claim is with the help of a local attorney familiar with bad faith insurance claims and the long-term health policy issues concerning the Baby Boomer generation.