What is a Retrospective Review?
If your family member or loved one has been in care for a period of time or if they have sadly passed away in care, we can help you to reclaim any overpaid care fees. This service is centred around Continuing Healthcare funding, we aim to demonstrate to the NHS that the patient’s needs would have met the criteria for Continuing Healthcare funding.Start Now
We will review your case and give you an honest recommendation and help you make an informed decision
on starting a claim to receive your overpaid care fees back as a refund.
The Review Process
01. Initial Assessment
Discharge from hospital - elderly patients who are discharged to a care home following a stay in hospital are entitled to an assessment. The discharge assessment show consider whether the patients health needs meet the criteria for funding.
Care Home Admittance Assessment - patients who are admitted to a care home directly from their own home, should also be assessed.
02. Ongoing Assessment
Every patient should have an annual assessment, often these don't take place.
Whilst a patient may not have been eligible initially, their health can deteriorate meaning they require reassessment.
Due to COVID-19 over recent years, very few assessments have been carried out.
03. Fast Track Assessment
Patients approaching their end of life are entitled to a fast track assessment. The assessment determines what additional level of support is required and the, along with the care home fees is funded by the NHS.
How Can Real Life Care Help?
We will request records as necessary and review the case. This ensures that all of the available evidence can be reviewed by the NHS.
We will contact the local CCG (Clinical Commissioning Group) to instigate a retrospective review.
We will complete any paperwork or questionnaires as requested by the NHS on your behalf.
We will discuss with you in depth the NHS’ review documents before these are submitted to the NHS panel to ensure that these documents are a true reflection of the patients’ needs.
We will attend the panel with you as your advocate if this is required. (Most MDT panels now sit closed but some CCGs offer a meeting before the MDT panel called a Pre-Panel meeting which we are invited to attend).
We will chase the decision and advise of any next steps.
If successful we will prepare and submit the proof of payments to allow for the NHS to calculate how much is due for reimbursement.
If unsuccessful after the MDT panel, it may be possible for us to appeal this decision at either local level or to NHS England.
The process may seem daunting, and can seem very complex. Which can be overwhelming, especially for a family member after their loved one has sadly passed away or is currently undergoing treatment. By allowing us to manage your claim, we can take the difficult parts away from you and hold your hand along the journey, making sure you are happy and receive what you are owed.
To help you get started, we have compiled a list of questions that we often get asked regarding the process.
Yes, the NHS has a duty to pay care fees for everyone who meets the eligibility criteria. If this was not done, or incorrect then the fees should be refunded to the patients estate.
No, there is no court visit in the process, there will be a panel discussion at the CCG (Clinical Commissioning Group) level which you may be able to attend, although many are closed, some groups do however hold a pre-panel meeting, which you may attend, we will be there on your behalf if you request.
Your initial consoltation is completely free. Once we have accepted your case, we will discuss the various funding options available to you.Start The Process Now