My father was recently hospitalized for a broken hip. Dad’s doctor told us that he’ll need post-hospital rehab following his stay to help him get back on his feet.
Now we’re trying to figure out how (or even if) the rehab will be covered by his insurance, but it’s been really confusing trying to sort through what’s covered and what’s not. Can you give me any info on how insurance works for rehabilitation after a hospital stay?
Don’t worry—you aren’t the only one left with lots of questions about post-hospital rehab and insurance.
In fact, we get questions about insurance all the time. To help you out, I’ve gathered some of the most common post-hospital rehabilitation insurance coverage questions and answered them below.
Just a quick note—you didn’t mention whether your dad has private insurance or Medicare, so I’ll make sure I touch on both.
Q: How much therapy will my parent receive after a hospital stay and will insurance cover it?
A: How much therapy your parent receives depends on their needs. Typically, someone who needs therapy following a surgery or hospital stay will get about five days a week of therapy covered by their insurance, with about an hour a day for each necessary discipline (physical, occupational and speech therapy).
When it comes to what insurance will cover, each plan is different—some might only cover 30 minutes as opposed to a full hour in a certain discipline. But generally, 30-60 minutes per discipline five times a week is typical for inpatient post-hospital rehab.
It’s also important to note that how much therapy someone receives can depend on their insurance plan, which leads me to the next question we get a lot.
Q: What services does my parent’s insurance cover during post-hospital care?
A: Again, this depends on the insurance plan. But typically insurance will cover therapy and nursing services, meals and activities.
The only thing that might not be included is a physician or specialist visit. However, most people can bill these services to another portion of their insurance.
For example, many people who receive rehab services at a MacIntosh community have either Medicare Part A, Part B or a Medicare replacement plan. Medicare Part A would cover therapy and services while Part B would cover physician visits.
Q: How long will insurance cover my loved one’s stay in inpatient rehab?
A: This can vary depending on your insurance. Most Medicare plans cover up to 100 days of rehab and skilled nursing, given that you meet the guidelines.
Commercial insurances are more variable—some have shorter benefit periods than Medicare. For specific timelines, contact a MacIntosh care community today. We can help you by reaching out to your insurance provider and obtaining the necessary information.
Q: How long will my parent need rehab?
A: This ties into the above question. Just because many insurances offer coverage for 100 days, this doesn’t mean 100 days will be necessary.
Insurance will only cover rehab for as long as someone needs it. You may wonder—“how is that determined?”
Well, typically how that works is the rehab center sends updates on a patient’s progress to their insurance company. The insurance company then reviews the reports and issues what’s known as a “last cover day.”
Trained doctors and nurses work at the insurance companies to determine these dates. But you do have an appeal option that we can help you with if you disagree with the assessment.
Q: What will my loved one have to pay out of pocket?
A: Most insurances do have some sort of daily copay. For Medicare or Medicare replacement plans, typically those copays start after around 21 days. But for commercial plans, that may start sooner.
Q: Can my parent come from home or do they need a hospital stay before insurance will cover rehab?
A: Medicare does require a three-night, inpatient hospital stay before becoming eligible for rehab coverage. By contrast, commercial insurances or Medicare replacement plans typically do not require a hospital stay. However, they do require a prior authorization.
At MacIntosh, we can take care of the prior authorization as long as we have the necessary medical information. It’s not uncommon for people to come into rehab from home, because sometimes people return home from the hospital too soon.
That actually brings up something else I wanted to address—as mentioned above, Medicare does require a three-night, inpatient hospital stay. However, if someone goes home after such a hospital stay and then decides they came home to soon, as long as they’re within 30 days of their qualifying stay, rehab can be covered by Medicare.
However, don’t wait too long. The more time that passes from the stay, the more difficult it can be to acquire the necessary information from the hospital.
Questions? MacIntosh Can Help
I hope those answers helped clear things up for you. If you have any other questions, please feel free to contact me.
All of our Directors of Admissions are more than happy to answer insurance questions. Every plan is different, so if you have questions specific to your plan and what it will cover at a MacIntosh care community, feel free to give us a call.
Director of Admissions and Marketing, New Albany