At The Forefront Of Disability And Elder Law

Why might your provider deny your long-term care insurance claim?

On Behalf of | Apr 25, 2023 | Elder Law |

As you age into the later years of your life, it may become apparent that you need daily support either in your own home or in an assisted living facility. There is no shame in turning to long-term care options, and there are even solutions to help you afford this type of care.

Long-term care insurance exists to reimburse you for some or all of the costs associated with receiving care and assistance in your daily activities. When the time comes to file a claim on your long-term care insurance policy, however, certain factors might lead to the insurer denying that claim.

When can a long-term care insurance claim meet denial?

One common reason for claim denial might be that the provider receives insufficient documentation to prove your claim eligibility. Another possibility is that a misunderstanding arose regarding what types of care the policy covers. On rarer occasions, a denial might occur because the policy contains a prior hospitalization requirement that is not actually enforceable in the state of Washington.

What can you do if an insurer denies your claim?

If you experience a claim denial, your top priority is to organize your records and speak to your doctor so you have all the necessary documentation on-hand to prove your eligibility. You should also carefully review your long-term care insurance policy with help from an insurance professional to ensure that your situation is eligible for reimbursement.

There are significant costs in paying for long-term care without support from your insurance policy. If your provider wrongfully denies your claim, it may be necessary to seek help.


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