SEARCH BLOG: HEALTH CARE
Before you rush out to get that "public option" coverage, perhaps you should have some idea how governmental bureaucracy [doesn't] works.
My sister-in-law has been going to physical therapy using her Medicare coverage. She was advised that she would probably need more than the "normal" amount of treatment. That's when she learned about the Catch-22:
1. On Medicare I have $1,800 per annum to cover physical therapy, speech therapy and occupational therapy. That's a total of any combination of the 3, not for each one.Just in case you didn't quite get that, let's connect the dots... once again:
2. any provider who agrees to take Medicare may not under any circumstances provide services that are not covered by Medicare for a medicare patient.
3. providers may not accept payment for any services directly from a patient under penalty of losing their license.
4. one may not apply for an extension of services until after using up the $1,800, so there will be a gap in the therapy.
5. I have recently met people who explain to me that if you stop going, because you've used up your limit and the provider cannot accept your payment, your application for increased services may be denied because you are obviously doing ok without it.
I'm particularly concerned about stroke patients who need either 2 or 3 of those services. at between $100 and $200 these services quickly reach the cap.
you may be able to find out a lot more at their website: http://www.apta.org/AM/
Template.cfm?Section=Therapy_I hope that helps. Cap&Template=/TaggedPage/ TaggedPageDisplay.cfm&TPLID= 188&ContentID=18639
If you need more treatment than Medicare considers appropriate, you can't pay to get it because the provider will be punished.Moral of the story: if you think you will be needing treatment for an extended period... don't let Medicare know and pay for it yourself. You may live longer... or at least get the treatment you need so you can enjoy living longer.
If you finish your treatment, you have to be approved by Medicare for more treatment and that can take awhile because you can't request additional treatment until you are done with the first round of treatment.
If there is a gap in treatment because you are awaiting Medicare approval... and you are surviving... that may be considered evidence that you don't need additional treatment.
dots have been connected for you.