Benefit Results provides a proven protocol and proactive approach that identifies eligibility issues which can be the cause for denials, can minimize Medicaid debt for facilities, and can make a difference for both the facility and the family.   Here are some of our latest results:

Loss of over $30k avoided plus ongoing coverage

Stuck in the Hospital

After 3 months of being unable to discharge from a hospital in northern Arizona, the social work team called Benefit Results for help. The hospital had been trying for months to get an ALTCS (LTC Medicaid)  approval to help pay for the needed care this young woman desperately needed. Due to an inability to track her resources while she was homeless and gather the necessary documentation to prove her resources, each application got denied. The hospital thought a guardianship was the answer but unfortunately, even the new guardian wasn’t able to secure Medicaid benefits. Benefit Results jumped in and with persistence, secured Medicaid benefits, assisted with placement during the pending process – this young lady is now safely in a behavioral unit, getting the care she needs! Great outcome for all!

New income secured! $783/month

Social Security Outcome

Skilled nursing facility member referred to Benefit Results under our contract with his health plan. Although physically able to discharge to a lower level of care, due to having no income he had not been able to. In order to move to an assisted living under Medicaid, the member must pay “rent” or a room and board amount—without income, there was no way for him to transition. Our team evaluated his situation, he was clearly eligible for SSI, so we submitted the Social Security application and within 31 days he was approved for SSI! His case manager is now working with him to move to an assisted living!

Loss of over $50,000 avoided and new benefits approved

Behavioral Health vs Long Term Care

Securing ALTCS for a member who has psychiatric issues can be challenging. Proving the medical rationale for benefits vs. mental health can cause delays and denials. Mr. B was in and out of hospitals and BHRF’s—never able to secure benefits that would cover his care in a long term setting. This gentleman had FIVE denials before being referred to Benefit Results. We worked diligently to coordinate all of the unique players including the Public Fiduciary office, worked with providers, secured documentation, and assisted with placement from hospital to a setting that would allow him to stay until approved. We are so pleased to finally see Mr. B be approved and able to unpack and settle into his new home with the care he desperately needed.

Benefits secured saving over $4500/month for wife

Wife Scared

Mrs. A worked for three months with her Medicaid eligibility worker, to secure benefits for her husband. He had been in a dementia unit in assisted living, pending benefits this whole time. No one ever mentioned to the wife that the trust they had on their home may cause her an issue with eligibility. At the end of the three months, as she expected to receive approval, she got the denial letter in the mail. The assisted living center administrator, with the emotional and scared wife in her office, called Benefit Results to help. After reviewing the case and offering compassionate support, the wife asked for our help. We were able to secure benefits for her husband in less than one month. She asked her Benefit Coach, why no one suggested she got help BEFORE applying the first time, as our assessment and support made all the difference. The key to successful benefit approval is making sure all of the ineligibility issues are identified upfront! Glad we could assist Mrs. A!

$8300 Revenue Recovered!

Assisted Living

The resident had been in assisted living since 2018 without the ability to pay her room and board due to an issue with her social security.  She had no identification and needed her social security reinstated.  Our facility partner called Benefit Results and explained the situation.   We were able to figure out the issue, deal with Representative Payee company, secure new ID, communicate with Social Security, and finally get her Social Security reinstated!   This was a Revenue Recovery of over $8300 to the Assisted Living and now the resident can pay her room and board and have her personal needs allowance!   Both the facility and the resident were thrilled with this great “result”!

Over $168,000 of Revenue Secured!

SNF Result!

Eight Medicaid Pending Cases in new partner facility managed and completed to ensure consistent revenue stream! Increased attention, management, and problem-solving got these cases finished and approved! Great Job! Over 24 months of coverage- all together – covered!

Revenue Rescued! - $19,500

SNF Result!

SNF Business Office applied for ALTCS. Application denied after three months due to the family not following through with needed documentation.  Benefit Results asked to intervene.  After Benefit Assessment and education provided to family, a new application was submitted and subsequently approved with Prior Quarter Coverage – No Loss Occurred.

Revenue Result - $18,000

LIHTC Assisted Living

Able to educate potential resident on identifying potential benefits with Wartime Pension that he did not know he was eligible for.  Made proper referral to VA claim agent, offered support during the application process.  The additional funds he could expect from the VA Wartime Pension gave him the reassurance he needed that he could afford to move into Assisted Living.  He was able to secure retroactive funds AND an additional $1830 each month that allows him to pay privately for his care!

Revenue Result - saved $8,000/month!

Single Case Agreement

Wife had so much trouble getting benefits to pay for husband’s care. She was fearful of spending down all of her assets.  Couldn’t figure out why she kept getting denied.  Referred to Benefit Results, after a comprehensive assessment, the answer was figured out, she was able to get needed documentation to show eligibility concern and was finally able to get approved for benefits!

Revenue Loss Rescued - $7,000

SNF Result!

During Benefit Assessment, identified income issue that social worker missed, able to secure needed items to get that month covered.