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A skilled nursing facility in NYS has the policy of giving short term rehab residents 5 days of therapy per week if their private insurance company will not increase the daily rate if they are given a sixth day of therapy. Some insurances will increase the rate, while others will not. If the rate is the same for 5 or 6 days of therapy, the nursing home gives the resident the option to pay privately for the 6th day of therapy. For residents with a private insurance company that only require 5 days for their daily rate requirement, are they entitled to the sixth day if they have a clinical need, without being asked to pay privately for it, provided that the rehab department is operational 6 days per week for other residents? If a resident has Medicaid coverage, I believe that they are entitled to the 6th day if there is a clinical need. Is that correct? Also, is there a regulatory reference that can be cited in either case?


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My brother received 5 days therapy a week per the choice of the Rehab facility, and this was their norm. He had excellent coverage with both medicare and AARP/United Health Care. Truth told, the therapists would often show up and take him walking outside (balance and adaptation his problems) on the weekends. Overall he got good care, though he felt that he was in control of nothing there and called it playfully "Being incarcerated". I think everything is so variable in these things, down to coverage, the facility practice overall and the doctor's orders. I do know there were weekly care conferences for such questions.
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Reply to AlvaDeer
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Maybe it depends on what the rehab is needed for. For my mom, it was weakness. Not much strength due to Parkinson’s. Skills to work on balance and strength.
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Reply to NeedHelpWithMom
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My brothers insurance a uthorized him for six days a week. My aunt, same doctor, same rehab/nursing home had five days approved.
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Reply to anonymous901498
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My mom had six days. Medicare with Humana Gold Plus supplemental insurance.
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