What to do when insurance denies payment for rehabilitation services and you cannot take care of him at home? - AgingCare.com

What to do when insurance denies payment for rehabilitation services and you cannot take care of him at home?

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59 yr old husband hospitalized with 2nd stroke. Admitted to rehab; after 6 wks insurance quit paying saying not making sufficient gains in therapy. Patient has had many chronic problems including severe headaches, c. diff infection causing severe diarrhea, is on PEG feeding tube and urinary catheter (also had UTI) and is battling dysphagia. Therapy has been very difficult and intermittent due to all medical problems. Don't insurance companies have to also consider the medical condition of a therapy patient? Can't participate much in therapy with 'poop' running down your legs or throbbing headaches. What to do now? My experience has been that the elderly and disabled are not given the same medical consideration as younger and/or non handicapped individuals.

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Have you spoken to the social worker at the rehab facility? Like Jeanne said, maybe your husband would qualify for Medicaid.
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If he's a veteran, check with the VA.
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I'm pretty sure that when Medicare is paying, a plateau in progress is no longer automatic grounds for discontinuing rehab therapy. I don't know if that is also the case for private insurance. I hope someone here will know that and respond, or know who you should contact about it.

Do the therapists feel he is capable of improvement, but at a slower and irregular pace?

Is your husband on disability? If so he may be eligible for Medicaid even though he is not of Medicare age.
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