Retrospective Review
What is a Retrospective Review?
You could be entitled to refund
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.
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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
This is the process required for
determining eligibility for care funding
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 aim to take the hassle out of the claims process for you to get your refund
Request records
We will request records as necessary and review the case. This ensures that all of the available evidence can be reviewed by the NHS.
Contact the local CCG
We will contact the local CCG (Clinical Commissioning Group) to instigate a retrospective review.
Paperwork
We will complete any paperwork or questionnaires as requested by the NHS on your behalf.
NHS’ review documents
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.
Attend the panel
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).
Chase the decision
We will chase the decision and advise of any next steps.
Submit the proof of payments
If successful we will prepare and submit the proof of payments to allow for the NHS to calculate how much is due for reimbursement.
Appeal this decision
If unsuccessful after the MDT panel, it may be possible for us to appeal this decision at either local level or to NHS England.
What are you
waiting for?
You could be entitled to reclaim thousands of pounds
of overpaid care fees. We can take to hassle out of
the claims process, and the whole thing is
no win, no fee.
FAQ
Frequently Asked
Questions About Retrospective Reviews
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.
How do I know if I'm eligible?
Eligibility for funding is complicated, you can read more about it on our funding page, but we find that many assessments are flawed and even if the patient was found not to be eligible for funding we can appeal this. if you have ever paid for care then it is worth getting in touch
Get In TouchMy loved one has passed away, can I still make a claim?
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.
Do I have to attend court for the claim?
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.
How much will the claim cost me?
Your initial consoltation is completely free. Once we have accepted your case, we will discuss the various funding options available to you.
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