Now What?

[dyin_myelin]

I have approval letter from my insurance company, prescription from my doctor, and endorsement from a recreational therapist. I am trying to get a home health aide. This is all I need. My insurance company will only bundle that with a PT or a nurse. I said PT but reiterated that I didn't need this service. I contacted the approved agency and a PT named Pat called me. She said that since I worked outside of the home it would be insurance fraud if she came out and she wouldn't do it. I could really use the HHA, what's the next step, or am I out of luck?

[Marco]

I believe outpatient therapy is your next step.

[SNOOPY]

Hi dyin_myelin,

The only time insurance covered any type of home care for me was when I broke my ankle and was non-weight bearing for 7 weeks (being able to walk took longer).

Insurance covered a PT coming into my home shortly before my surgery and there after for twice a week. After a little over 2 months, when I was able to walk and drive insurance no longer covered my in home PT.

[Kimba22]

Medicare should pay for therapy services to maintain your condition and prevent you from getting worse as long as these services require the skill or supervision of a licensed therapist, regardless of your potential to improve.

http://www.medicareinteractive.org/p...t&script_id=69

I also wanted to clarify this only applies to Medicare, not private insurance. http://www.medicareadvocacy.org/medi...ment-standard/

But, as wonderful as this all sounds, there are still episode caps that limit these services for anyone who has a chronic condition, like MS. http://www.medicareadvocacy.org/caut...-payment-caps/

No matter what, it seems like we can't win.

[aitch10]

I believe outpatient therapy is your next step.

This. Why does PT have to be at home?