Long-Term Care Billing
Merlin Law Group is not a collections firm, nor do we go after patients. Merlin Law Group goes straight to the source that should be paying the long-term care insurance claim, the health insurance company. This plan of action is mutually beneficial to the assisted living facility or nursing home, and the patients receiving care. Patients receiving in-home long-term care can also benefit if their insurance claim is delayed, denied, or underpaid.
Merlin Law Group has long-term care facilities on a bulk claim basis as well as an individual claim basis. Analysis of your claim or billing situation is a courtesy. When your patient may be struggling mentally or physically it may be easier for our attorneys to work with the facility rather then the policyholder.
When long-term care facilities process a medical service claim with a health insurance company, the insurance benefits to which the claim relates belong to the patient or belong to the long-term care facility by way of the patient’s assignment of benefits. This is how Merlin Law Group can represent the long-term care facility on behalf of the patients. This option eliminates direct patient billing, collections, or settling for a tax write off.
It should come as no surprise that there are many different ways in which an insurance company’s claim decision can be erroneous. For example, the claim may have been underpaid or denied because of a simple administrative or clerical error. As another example, the claim may have been underpaid or denied because of the insurance company’s misunderstanding of the factual circumstances surrounding the services that were rendered. As another example, the claim may have been underpaid or denied because of a misinterpretation / misapplication of the insurance policy or the law. The Merlin Law Group’s insurance attorneys have seen it all and are accordingly well-versed in analyzing insurance company claim decisions and unwinding (via letter writing, statutory remedies, appeals, external reviews, mediation, litigation, or et cetera) incorrect claim decisions. Of course, when the Merlin Law Group achieves payment from the appropriate source (the insurance company), you end up the hero for having pointed your patient in the right direction.
The Merlin Law Group’s initial assessment of the insurance company’s claim decision is a courtesy. The terms of representation will be discussed if it is determined that the insurance company’s claim decision was wrong and that the Merlin Law Group’s services are warranted.
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