Denial of Rehab Based on Provider Policy – Get a New Provider

In the past month alone I have spoken with two clients whose in-home rehab therapy was terminated.  The first termination was because the provider did not believe further improvement was possible.  This decision conflicted with the patient’s doctor’s recommendation and the patient knew she could improve further.

The second involved termination because the provider said there had to be a four week break.  In this case the patient would just get stable on his walker and then would lose it during the four week layoff. It was clear he needed rehab therapy to improve or at least maintain the function he obtained.

The simple law of Medicare is this: Skilled therapy services may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.  Medicare B will cover in-home therapy for an indefinite period where the patient’s doctor recommends it and the record shows the need for a professional therapist.

The moral: get a new provider if they terminate therapy and you and your doctor disagree with the termination.

Jim Schuster, CELA

Jim is one of 18 Certified Elder Law Attorneys in Michigan. He has numerous titles in the Elder Law field , including former Chair of the Michigan State Bar Elder Law Section, and has been a licensed attorney since 1978. His clients like his caring, respectful handling of their problems.