There is no doubt that American healthcare is in crisis. With a dwindling number of doctors, nurses, and other healthcare professionals, patients often wait months to schedule office visits and elective surgeries. However, that’s just the tip of the iceberg. Most major insurers set very low caps on services they will authorize payment on and among those would be extended hospital stays.
Even when the patient can self-pay, some rules and regulations deny them that alternative. So then, what if going home after surgery is not an option but the hospital isn’t able to justify an extended stay for such things as therapy? Here are some options you may want to consider.
Short-Term Rehabilitation Therapy
The almost unbelievable aspect of some insurance plans is the fact that they impose ceilings on coverage but will also disallow private pay for services they won’t cover. A case in point would be Medicaid in the State of California. Only certain medications are approved, and most often only generic medications will be paid for unless a TAR is submitted and approved. A TAR is simply a “Treatment Authorization Request”, which covers any services, treatments, or medicines not covered under California Medi-Cal. Therefore, if you live in California and Medi-Cal won’t sign off on an extended hospital stay for rehabilitation therapy, you might be out of luck if the rules say you can’t self-pay.
If you find this to be the case in other states and with other insurers, public or private, you might be able to get approval for an assisted living facility that offers short-term rehabilitative services. For example, McKnight Place assisted living facility in St. Louis, MO has a full staff of 24/7 on-duty nurses and doctors along with therapists who can provide the services you need. Some insurance plans will cover or subsidize the costs involved and others won’t. However, your ability to self-pay may not be denied in that state.
Temporary Stay with Family or Friends
This may not be one of the best solutions depending on the amount and kind of therapy you require. While you wouldn’t be left alone trying to cook, clean, and care for yourself, your family members may not be able to provide the level of care necessary during your convalescence.
This is a service that might be an option, even under increasingly strict Medicaid regulations. With that said, your provider may only authorize payment for that short therapy visit, and the rest of the time you would be left to fend for yourself. If you can pay the costs of home health care nurses to be on duty 24/7 during rehabilitation, that could be an option. However, wouldn’t it be safer and much better to find short-term assisted living facilities with around-the-clock care and other amenities to make life more cheerful?
The one final piece of advice would be to stand fast in your resolve to get the services you need for a safe and full recovery after surgery. While you can’t refuse to leave the hospital past the date your insurer is willing to cover, you can always find alternatives so that you can get after-surgery rehab services necessary for a complete recovery.