Can inpatient OT/PT be discontinued by insurance? - AgingCare.com

Can inpatient OT/PT be discontinued by insurance?

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Subject says it all. Original plan was intense therapy for two weeks inpatient, then 2-4 weeks inpatient less intense facility. Now at 11 days in hospital gets call from insurance last night to discharge her today TO HOME! I work, should I appeal to delay the discharge, what do I do. My wife is doing well physically but has very low cognitive skills (brain damage). THANK YOU IN ADVANCE!!!!!!

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Vandy, is it Medicare ur dealing with or private insurance. Answers given really depend on what you have. Please get back to us on how it turns out. It may help someone else having the same problem.
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Katiekate, Medicare when it comes to rehab, only pays fully the first 20Days. From 21 to 100, 50percent. Supplimental may pick up the difference but with my Mom there was a "share" clause and she paid $150 a day.
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Thank you for all the quick replies. OT and PT are going fabulously (really), she just has severe memory loss and no ability to form new memories. The Rehab Hospital is blaming Insurance, but I am on the phone with them now seeing if they did in fact discontinue paying/authorizing treatment.

He said/she said. LOL
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Medicare will only pay for a max of 90 days...and ... only if the patient continues to improve. Once improvement stop, Medicare payment stops.

Further, if it is no longer authorized by Medicare....the Medicare part B supplemental insurance also stops payment for the service. Supplemental insurance is authorized ONLY through Medicare. No Medicare payment means no supplemental insurance payment either.

You can push back on the discharge. Insist that the inpatient services work to find a rehab for her. You can submit an appeal to the discharge...but, they act fairly quickly on those, so you would be unlikely to gain more than a day or 2 at the most.
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I am assuming the hospital has a therapy department? Where I live, they don't and therapy is done at a rehab facility. Maybe the insurance company won't pay for anymore days at the hospital but will at a rehab facility.
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Vandy, chances are that the physical therapy group finds that your wife is not progressing at the rate she should. You could try to appeal this decision if you think that she is improving.

This reminded me of when my Mom lived in Rehab, Mom was telling us that she was walking, etc. which surprised us as she had a serious head trauma due to a fall. Turns out Mom never was walking, she couldn't even stand. There was nothing more that OT/PT could do for her. Thus the facility decided Mom should either move back home or into long-term-care.
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I am assuming ur not on Medicare? Call the insurance company and ask for the reason for the discharge. Maybe they don't have all the info needed. (No info from therapist). Or talk to the Social Worker at the facility and see if she can find out the reasoning. Explain that arrangements needvto be made on such short notice since you work.
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