Filing A Long Term Care Claim in Houston, TX


          Among the 2.7 million Texans aged 65 and older, most will require some form of long term care. Also, between 1/3 and 2/3 of all disabled Texans who require long term care are not elderly. Whether care includes Hospice, stays at the nursing home, hospital visits, medical visits or equipment at home, or assisted living, long term care is very expensive. At an assisted living center in Houston, for example, you can reasonably expect to pay an average of $3,545 a month (the minimum for care in a nursing home can reach minimums of $6,000 a month).

          Because this care typically helps individuals maintain a lifestyle as opposed to treating or curing illnesses or disabilities, insurance policies should provide financial security and peace-of-mind. However, the system is not perfect. Imagine your parents or a loved one bought a long term care policy and paid its steep premiums since. When an illness or disability affects their ability to take care of themselves, the insurer should be there to help, right? In some unfortunate cases, no.

          It’s a widespread problem that occurs far too often than it should, and insurance companies need to be held accountable to their policyholders. At Herren Law, we side with policyholders who’ve paid their dues and should receive the benefits they need. With over 20 years of experience, we’ve established a successful system for getting people their rightful benefits, and we’ll help you too.

          Contact Herren Law today at (713) 682-8194 for a free initial appointment.


The Process For Filing for a Long Term Care Claim


          A long term care claim is a formal request to your insurance company regarding financial compensation. If you have an insurance plan covering long term care, the insurance company should then step forward to cover some of the following expenses:

  • Home Care
  • Assisted Living
  • Respite Care
  • Hospice Care
  • Nursing Homes
  • Alzheimer’s Facilities

          Depending on your specific plan and insurance company, the policy could also cover live-in caregivers, therapists, and private duty nurses.

          After filing a claim, your insurance company will diligently comb through it. Although they aren’t looking for the tiniest excuses to deny a claim, it is always best to file the strongest claim possible and increase your chances for coverage. Therefore, a long term care claim must have all of the necessary documentation ready, including statements from medical professionals, medical bills, home care bills, and accurate representation of your loved one’s illness or disability.

          Incomplete or substandard claims could delay the claims process or result in a denial. With a Houston disability attorney at your side, we will work through the claim process with you, making sure that no stones are left unturned and that your application is as strong as possible.


What to Do If Your Claim is Denied


          When policyholders or their families file a claim and the insurance company denies it, the emotional toll can be devastating. Heart-breaking questions abound at this point, such as, “How will I pay for this?” or “How can I give my mother or father the best care possible, as they would do for me.” Working with over 4,000 people from Houston and the surrounding counties, I’ve personally encountered these questions, and they are one of my central motivations for helping people and their families receive the benefits they need.

          There are many reasons, aside from substandard documentation (a vague concept in itself, as a strong claim requires going beyond the minimums set forth by the insurance company), why a claim is denied. Some of which include:

  • Lack of proof that an insured person is receiving care from an “eligible care provider” in a nursing home or assisted living facility.
  • Lack of proof that an insured person needs help with 2 out of 6 activities of daily living, including bathing, dressing, eating, transferring, toileting, and continence. Cognitive impairment that requires substantial supervision also fits within this category.
  • Denial of benefits for personal care
  • Failure to pay claims due to cognitive impairment

          This is not an all-encompassing list, and your insurance company could have their own reasons for delaying or denying a claim. If you claim is denied, however, it is essential to get the help of an experienced disability attorney right away. The health and wellness of your loved one as well as your future finances could be gravely at stake!


Contact a Houston Social Security Attorney to Protect Your Rights


          At Herren Law, our main objective is to ultimately get you or a loved one the care you need. Therefore, as Houston’s leading disability lawyer, we understand ERISA, the various long term care policies, and the most popular long term care insurance providers. These providers include Genworth, Mutual of Omaha, Mass Mutual, Transamerica, and several others.

With a vast network of resources, including medical and insurance professionals, as well as diligent litigation strategies and a compassionate ear, Herren Law gives you the best chance to build a strong claim and protect your rights.

          Contact our office today and receive a free, initial consultation with the top disability attorney in Houston. Call now at (713) 682-8194.