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