Follow
Share

Dad fell last December at an ALF and I got him to the VA hospital. they sent him to a SNF, which was paid for by medicare. now he has VA Home Based Care, which means they provide him the care instead of medicare, but he has medicare options to go out to private care if he needs it.

but now, VA only approves him for 6 visits, which is 2 weeks, which is nothing ... he could use PT for 2 months to get him on his feet again. it could be that the VA doesn't think he's going to get any better, but they wont say. they are very hard to reach.

My question is: does medicare pay for PT if a doctor prescribes it? or is it part of the skilled nursing that wont pay after so many days pass? or is it subject to the 20% deductible? he has no advantage plan because one of the skilled nursing canceled it because getting the bill paid by medicare is so much quicker. this stuff need a college degree to understand! thanks! Linda

This question has been closed for answers. Ask a New Question.
Medicare has been working toward allowing PT if it keeps people from going backward, but to the best of my knowledge that hasn't gone through yet. We can hope that eventually it will.

At this time, as the others said, it's still generally based on whether or not a person is making progress. I agree that no therapist is likely to predict what will be needed since there's really no way to know.

There must be some misunderstanding about the Medicare Advantage plan being cancelled by someone else. If a person goes on Medicaid, then other provisions can be made, but if he's under Medicare then he has chosen and paid for his own supplemental insurance. Medicare Advantage is private insurance supplemented by Medicare.

I'd call his Medicare Advantage provider and ask some questions.
Please let us know how you are doing with all of this when you have a chance.
Carol
Helpful Answer (0)
Report

Well, first, no one other than dad or his power of attorney (after jumping through enough hoops to entertain a crowd at a circus) could cancel his Advantage Plan. So I don't know what that's about.

Talk to the physical therapist. I'm surprised they're doing three a week -- I actually like that better than the therapy mom got -- 2X a week. At any rate, talk to the PT. It's possible (almost probable) that with his/her recommendation, he'll be re-upped. Get cozy with him/her and learn all you can.

Even Medicare only approves "as we go along," meaning that, as long as a person is showing improvement, they will continue.
Helpful Answer (1)
Report

General answer, not specifics; PT and other therapies get approved in little bits, depending upon whether the patient is making progress. No therapist will predict what is going to happen.
Helpful Answer (1)
Report

If he shows progress in those two weeks, it will likely be continued. It all depends on his ability to progress.
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.