When can I appeal?
If an insurance company says you do not qualify
for long-term care benefits, you may be able to appeal. Disputes most
likely involve decisions about whether you can no longer perform certain
activities of daily living or have a cognitive impairment.
To avoid claim denials, it is important that
the facility or caregiver keep accurate, detailed care notes about
the level of help a policyholder needs to perform activities of daily
living. The insurance company will use this information in the claim
How do I appeal?
- Your first appeal is through the company that denied coverage.
- If the denial is upheld by the company, your insurer must send
you a letter telling you how to file an external appeal. The letter
will include this list of Independent Review Organizations.
- You may select the company you want to review your case. If you
don't name a company, the insurance company will do so on your
Independent Review Organizations
LTCI Independent Eligibility Review Specialists,
Stephen R. La Pierre
MCN (Medical Consultants Network)
Medwork Independent Review
Eau Claire, Wisc.
Gail A. Tasch