Reasons Medicaid/MassHealth Applications get Denied

When you require the long-term care that Medicaid (known as MassHealth in Massachusetts) provides, it can literally be a lifesaver. Unfortunately, a significant percentage of claims for these services are denied which is especially disheartening when your health or the health of a loved one is on the line. 

To avoid having your claim denied or for assistance in dealing with the appeals process, you need a strong Medicaid/MassHealth attorney with the knowledge and skill set to navigate through the bureaucracy. In Southeastern Massachusetts, the law practice of Surprenant & Beneski, P.C. is well-prepared to help. Contact us so we can meet with you to understand the details of your case and work out the best strategy to obtain eligibility.

Why You Need Legal Advocacy to Deal with a MassHealth Denial

As you are probably already aware, there are strict standards for receiving MassHealth benefits. Often, even if you meet those standards, actually getting them can be a challenging process. 

Any of the following may be a snag in your attempt to receive the benefits you need for medical care. This is when having a sharp attorney at your side can make all the difference. Besides having in-depth knowledge of the system, our lawyers have years of experience dealing with MassHealth matters and interacting with the personnel in charge. This will put you at a sizable advantage.

Reasons for Denial of Medicaid/MassHealth Denials 

The most common reasons for Medicaid denials include:

1. Having Too High an Income or Too Many Assets

In order to qualify for Medicaid, you must have extremely limited financial resources. Nonetheless, with the help of one of our knowledgeable attorneys, we can definitely make receiving benefits possible even if your resources are over the limit. The well-informed lawyers at Surprenant & Beneski have a number of proven methods to help you become eligible for benefits while still protecting your assets, such as by creating trusts.

2. Not Filing Claims at the Right Time

Some applicants make the mistake of filing for benefits too early — before they are financially or medically eligible for benefits. Others file too late. If an applicant has already moved to a nursing home, perhaps under urgent circumstances, Medicaid will only provide retroactive benefits for 90 days. If the patient relocated a year ago, that individual will be held responsible for the first 9 months of their stay in the facility (a huge expense).

3. Incomplete Application or Documentation

As expected, the demands of MassHealth for detailed, accurate information are exacting as well as time-sensitive. Not only should you make sure that your application is completely filled out, but that you are submitting every single document requested. A missing or incomplete Physician’s Statement, for instance, could delay your request for a considerable time or lead to a denial. 

This is why our Medicaid attorneys take the time to review all applications and other documents carefully, and to make certain that all papers sent to MassHealth initially, as well as all replies to follow-up requests, are sent punctually.

Contact Our Experienced Medicaid/MassHealth Attorneys Today

Anyone who has had to navigate the MassHealth system in order to receive benefits will tell you that it is no fun. In fact, it is demanding of your time and patience, frustrating, and at times feels like an exercise in futility. 

The skilled attorneys at Surprenant & Beneski know that you are already coping with a serious medical condition. We sincerely want to make your life easier by making the MassHealth application process go more smoothly. We are also aggressive negotiators if we have to fight a denial of your claim. Your chances of a successful outcome are greatly increased when you have us in your corner. Contact us now so we can take over this burden.