Continuing Healthcare FAQ’s

Is the entire UK covered by your service?

No there are different rules and funding systems in Northern Ireland and Scotland, and unfortunately we are not able to provide patients with any services whose care is provided or funded in Northern Ireland and Scotland, we can deal only with patients shoe care is provided and funded in Wales and England.

Am I required to pay for my own Long Term Care costs?

Currently, if you own assets worth over £23,250, then you will be required to pay for your care costs, whether that care is at a Residential or Nursing Care Home or your own home. This £23,250 doesn’t include your property’s value if another dependent or your spouse lives in your house. However, the most important point that you need to understand is if you believe you have any “primary health care needs,” then you should first have an assessment done to see if you are eligible to get NHS Continuing Healthcare Funding.

If you are eligible to receive NHS Continuing Healthcare Funding, then you won’t be required to pay for your care costs, no matter how wealthy you are, and the NHS will be required to pay for it.

To get more detailed information on your eligibility to receive NHS Continuing Healthcare Funding, gt in touch with one of our team members, or download one of our FREE guides for help.

How does the NHS Continuing Healthcare Funding process work?

The assessment process has two stages to it. The Checklist Assessment is the first stage and usually a nurse or doctor carries it out, either in a Care Home or hospital. The Checklist assessment will review the care requirements of a patient in several areas and then allocate a score for determining how severe the health care needs are of a patient. If it is suggested by the initial Checklist Assessment that the patient might qualify to receive NHS Continuing Healthcare Funding, a Full Assessment is then conducted by members of the Multi Disciplinary Team (MDT) which are comprised of other healthcare professionals that are relevant to the patient’s situation. The MDT conducts a further assessment which is based on healthcare criteria that are similar to the original ones and offer a recommendation to the local Clinical Commissioning Group with regards to eligibility, who then makes the final determination for the NHS Continuing Healthcare Funding for eligibility.

You need to understand that we hear from clients on a regular that staff inside of the NHS frequently suggest that a patient will not be eligible to receive NHS Continuing Healthcare Funding before an Assessment has been undertaken. So it is critically important to understand what your “rights” are in having an Assessment done.

To receive more detailed information regarding your eligibility to receive NHS Continuing Healthcare Funding contact one of our team members, or download one of our FREE Guides for more help.

Is it possible to deal with the NHS on my own?

Yes you can. You have the right to ask for an Assessment for your eligibility for NHS Continuing Healthcare Funding on your own. You can manage the entire process on your own and the FREE Guides that we provide you with are designed to help you better understand how to work your way through this process. However, many of our clients have told us that this process is frequently daunting and difficult, and that is why we provide clients with our Advisory Service, where we can act on your behalf during this process.

On the Money Saving Expert website Martin Lewis says that we don’t usually believe in using claims handlers or lawyers for things that are easy to do on your own, like PRI Reclaims, since they take a cut from your payout. However, even though we believe it is possible for you to reclaim care costs on your own, in this case we aren’t militant about it. If you need help and are struggling, then we strongly advise that you use a solicitor instead of a claims handler. But you should never pay anything up front, and make sure it’s done on the basis of ‘no-win no fee.’ Lawyers are regulated, while care cost claims handlers aren’t. If you are not happy with the claims firm, then all you can do is contact the Trading Standards and complain.

We thoroughly understand the complexities that are involved in the Assessment process. We utilise all of our legal expertise along with the clinical expertise that is provided by our senior nurses in order to provide our clients with the best chance to secure funding, which includes deal with the Appeals process whenever that is needed.

For more information regarding the Advisory Service that we provide, please contact one of our team members.

I had an Assessment already and didn’t qualify, or I have an Assessment appointment soon – what should I do?

If you had an assessment already and did not qualify to receive Funding, contact us so we can discuss your Assessment with you. The NHS is supposed to give you a copy of your Assessment and we will be able to advise you on whether or not we think there are grounds for Appealing the decision. If you already have an appointment for your assessment, contact us and we will be able to make arrangements to represent you during your Assessment meeting, to provide you with the best chance of obtaining a successful outcome.

How many individuals qualify to receive NHS Continuing Healthcare Funding?

According to the most recent NHS statistics, there are 58,000 individuals who qualify to receive NHS Continuing Healthcare Funding currently. However, with 450,000 individuals in care currently, we believe the number of individuals who should be able to qualify to receive Funding is a lot higher – maybe up to 150,000 individuals. People frequently miss out on receiving Funding in many situations, including:

  • Being discharged directly to a care home from the hospital.
  • Individuals who were assessed for eligibility and were rejected but whose condition worsened subsequently.
  • Individuals who were given NHS Nursing Care – that pays for nursing services, but not for accommodation – who did not get an assessment for the benefit to pay for their accommodation as well.
  • Patients who are more affluent who assume no help is available to them. NHS Continuing Healthcare Funding isn’t means tested, so you receive it as long as you qualify based on health reasons.

So don’t miss out.

To receive more detailed information regarding your eligibility to receive NHS Continuing Healthcare Funding, contact one of our team members, or down one of our FREE Guides for more help.

How much do you charge for your services?

The funding option that is the most common for us is acting under what is called the Non-Contentious Business Agreement. That is essentially a type of No Win No Fee agreement, and you are only charged if we succeed in obtaining NHS Continuing Healthcare Funding for you. If we are not able to secure Funding, then you won’t be charged anything, except for disbursement costs, for example to obtain your medical records. If you do receive funding, then you will be a charged a percentage of what your Care Costs would be if you didn’t qualify for funding. The charges are based on just the upcoming 12 months of your Care costs.

On our services for Retrospective Claims, we offer to provide the service only under an NCBA.

We always fully discuss all funding options with you prior to agreeing to act on your behalf, in order to ensure that you select the best option for your situation.

We provide an initial assessment FREE of charge on your eligibility, so please contact one of our team members to find out how to receive your FREE initial assessment.

I have paid for my Care already – will I be able to claim back those costs?

If you were eligible to receive NHS Continuing Healthcare Funding and didn’t claim, or didn’t know you were actually eligible, you will be able to claim back these costs you paid for your own care for the time you should have been eligible. This process is one we can assist you with, which involves having a retrospective assessment done on your healthcare needs. However, there have been some rules imposed by the Government for covering claims for Care Costs that have been previously paid. You are unable to recovery any Care Costs that you paid prior to 31 March 2012, unless submitted a claim already prior to the deadline.

You also need to be aware that you an recover your Care Costs that you paid after 31 March 2012, for a friend or relative who might have passed away since.

For more information regarding the Retrospective Care Cost Claims Service that we provide please get in touch with us and talk to one of our team members.

What will happen if I end up not qualifying to receive NHS Continuing Healthcare Funding?

We always provide a FREE initial assessment for your eligibility to receive NHS Continuing Healthcare Funding. If we don’t think you are eligible to receive Funding, then we will inform you of that from the start, or it might be we are unable to get Funding secure for you even following an Appeal.

In those situations, you will need to pay for your own Care costs, depending on the value of your assets.

However, keep in mind that you are still eligible at any time for re-assessment, if you think there have been changes in your healthcare requirements. Normally we will stay in touch with you when you are deemed to be ineligible initially so that we will be able to advise you in the the future of your changing eligibility.

Until that time, if you have assets worth more than £23,250 currently (excluding your property if another dependent or spouse lives on the property) then you will need to pay for your own Care costs.

If your Assets are worth less than the threshold of £23,250, then your Care costs will be paid for by the Local Authority who is obligated to provide accommodation for you in one of its Care Homes. (If your assets are worth £14,250 to £23,250, then you will still be required to pay for some of your costs – for more information, see our FREE Guides).

If you are required to pay for your own Care costs, there are several options that are available to you when it comes to your Care and the Residential Home that you select and you might benefit from getting specialist financial advice that can help you plan for your Care costs.

In that type of situation, please contact one of our team members for advice.

What can I do in the future to protect my assets?

There are ways to mitigate Care Costs legally. However, if you do have a need for Care impending, then it might not be possible for your costs to be mitigated. Seek out specialist legal advice to help you with your specific circumstances by contacting one of our team members to discuss your situation. Frequently the relatives of a patient who is in Care will understand how important future care planning is. It is a very good idea to get advice early on in the process for how to prevent having to pay all of your won Care Costs later on in the future, through seeking out specialist legal advice now, which is something that we can definitely assist you with.