Long-term care

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 review process.

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 behalf.

Independent Review Organizations

LTCI Independent Eligibility Review Specialists, LLC
Allentown, Penn.
Stephen R. La Pierre
800-878-9579
slapierre@iberview.com
www.ibereview.com

MCN (Medical Consultants Network)
Seattle, Wash.
Erik Halse
206-343-6100
ehalse@mcn.com
www.mcn.com

Medwork Independent Review
Eau Claire, Wisc.
Gail A. Tasch
800-426-1551
Independent.review@medworkiro.com
www.medwork.org

Permedion, Inc
Westerville, Ohio
800-473-0802
hmspermedion.com

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