Things you didn't want to know until you were older...

I came home from work yesterday and as is accustomed asked how everyone’s day was. Dad still does physical therapy Mondays and Thursdays. He tried to tell me something about therapy. From what I was able to ascertain it sounded like Thursday would be his last day in therapy. I said I would call in the morning to get the scoop as Dad’s yes’s and no’s can still be confusing on occasion and I couldn’t tell if he was quitting, if they were discharging him for no improvement or it was something else. Turns out it was the something else.

As I’ve written before, how our bodies and minds can heal is incredible and mind boggling. Much like there is no time limit on grieving, so too there is no time limit to improvements we can make after something traumatic like a stroke, as Dad has proven. There is; however, apparently a time limit on when your Medicare benefits run out for therapy services. This is what has happened with Dad.

So the skinny of it is this: Medicare has a cap on the amount of money paid out for Physical, Occupational and Speech therapy. There are two gaps limits. For some unknown reason physical and speech have a combined cap of $1920.00 while occupational gets its own $1920.00 threshold. That’s the 1^st cap. After that is reached and your still showing improvement there is a second cap of $3700. Once you have reached that Medicare pulls out and requests that should therapy still be warranted, still be needed, your records be sent to them for review, because now you have to begin an appeal process. The therapist essentially has to plead and beg through progress reports that therapy is still needed, warranted and will continue to benefit the patient. This is where we are with Dad right now. He is still improving, greatly, through physical therapy to the point where he has graduated to a quad cane instead of his somewhat cumbersome hemi-cane. This is huge news for us and Dad as it demonstrates his improvements over the last year and a half.
The worse case scenario is that the Medicare caps are yearly so he can start back up January 1st with physical therapy again (even though we don't really want him going that long without some kind of therapy). There is also paying for it out of pocket (although how many people on a fixed income can afford that). There is supplemental insurance which I have to look into what options there are for them to foot the bill. Either way there are a few different options for us as we await this appeal process with Medicare (in which he could still be denied services).
All of this is a result of changes made this year by the government. What can you do? Stay informed and become an advocate my friends. Here is a link with more information about this subject. 

http://www.medicareadvocacy.org/medicare-therapy-caps-a-call-for-repeal/