Long Term Care Claims Denials – What You Can Do

Long Term Care Claims Denials – What You Can Do Twin Cities MNAccording to a study funded by the U.S. Department of Health and Human Services (HHS) in 2008, 23% of consumers filing long term care insurance claims found it difficult. An initial claim kit sent by an insurance company may be 25 pages and require doctor’s records, caregiver time sheets, billings care provided. All of those must match up and be covered by the policy. While the industry reports paying 97% of claims once complete documentation has been received, that does not include how many people give up trying.

There are companies that can help you get your claim filing done accurately and give you the best chance of avoiding denials. One such company is Family Solutions For Care (FSC). Wendy Rinehart, FSC’s Founder and CEO told us that the top reasons for claim denial are:

  1. Missing or Inconsistent Care Provider Notes. Time sheets must match care notes and both have to match end-of-month invoices.
  2. Missing or inconsistent Medical Records. A physician’s letter does not help a claim.  It must be documented in the patient’s medical records that they need care as defined by their long-term care policy.
  3. Care Assessment Report. This is the most human part of the process and potential claimants don’t like to admit they need help to complete strangers; and assessor reports do not always provide the documentation required for an eligible claim.

Wendy said there are things you can do to help get your claim approved. They include:

  1. Make sure you have a complete copy – and have read it – of the long-term care insurance policy before a claim is submitted.
  2. Make sure the potential claimant is not alone with the assessor when the interview is conducted. You cannot “cue” a claimant, but you can observe and keep notes from the assessment.
  3. Request a full copy of the assessment report.
  4. Monitor and collect daily care notes and time sheets and compare to invoices at the end of the month.
  5. Request a copy of any medical records that are going to be sent to the insurance carrier and review them for consistency before they are forwarded to the insurance company.
  6. Keep a record, including phone number, date and time, person you spoke with, question and outcome of each conversation with the insurance company.
  7. When faxing or mailing claim information to the insurance company, keep a copy, and note the date.
  8. Follow up after claim documents are submitted to make sure all have been received and to see if there is any missing information.
  9. Don’t take the first no for an answer.
  10. Request Professional Assistance.

Number 10 above is where FSC comes in. They have four types of services. The first one is a FREE 30 minute long term care policy review. It can help you determine whether a claim is likely to succeed. After that they can offer you hourly consultation, help you with your claim or provide full long term care support. You can choose how much help you would like. Wendy and the team at FSC are there to support you at what is often a very stressful time.

If you would like to use their services give Choice Connections a call and we will get you connected.

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