Insurance Appeals

Medicare, Medicaid, Private Pay Insurance…we can help you be successful in your insurance appeal.

Every little bit helps.  But, when it comes to medical issues, a little bit can mean a lot.  If you are in a situation where your plan has cut off benefits or is limiting your use of benefits, we can advocate on your behalf to ensure that you are maximizing your plan’s potential.  You may benefit if you are in a situation in which:

  • A Managed Medicare plan has cut off rehabilitation benefits before an individual has reached his or her maximum potential with therapy
  • Medicaid has denied payment for long-term care based on a Medicaid nurse clinical visit

Our care managers will:

  • Help you navigate the complicated Medicaid, Medicare, and insurance system
  • Request and review all medical records related to the denial
  • Provide a Certified Nursing Assessment
  • Interview physical therapists, nursing and other medical care staff
  • Formulate a strategy and begin the necessary process for an appeal review or hearing
  • Testify when necessary and follow through to completion and final judgment

A winning insurance appeal provides financial and quality of life benefits.  Clients get the care that they need – whether that means access to additional therapy, long-term care services, or necessary home modifications and repairs.  Families may be reimbursed for services for which they have already paid, and may be relieved of further financial responsibility.