The Confusing World Of Rehab: Insurance

As with all things in healthcare these days, it is driven by insurance.  This is the case with rehabs.  Most all insurances have hospital and rehab benefits. In private insurances, the covered varies as do coinsurances and copays.  The average fro rehab coverage is 100 days.  On admission, request the billing department or case management to give the exact amount of coverage available with your insurance.

Medicare coverage Part A is as follows: For hospital rehab or acute care rehab day 1-60 is completely covered except for the deductible, days 61-90 are covered with a coinsurance.  Many of the medicare supplemental insurance, will cover the coinsurance.  The plans that don’t are the basic supplemental plans.  You will need to check which plan you purchased.  After 90 days, there is a Lifetime Reserve of 60 days.  This can only be used once and is not replenished.

For subacute or a skilled nursing facility, you are entitled to 1oo days.  Days 1-20 are fully covered; days 21-100 have a coinsurance.  Again, If you have supplemental insurance, the coinsurance may be covered.  Check the policy or call medicare or your insurance carrier.

Medicare is very clear that 15 hours a week of rehab therapies must occur in order for payment.  The facility will need to continually send information to Medicare for your stay.

Once your days are used up whether private or medicare, you will be billed!  Before this happens, it is advisable to speak with the case manager or billing department to start the financial aid process.  Daily bills can run from $150-400 a day.  Be aware of what day your family member is on.  The facility may not tell you, the payment has been shifted to you.  Many will tell you and demand a monthly payment upfront.  If no payment is made, they will start to look at your assets.

In some cases, it is possible to get a private insurance to pre approve more days.  It will mean going through an appeals process.  Medicare has no wiggle room.  At 101 days they stop payment.  I cannot say it enough, make sure you track how many days are used.  You don’t want to be caught off guard.