Quote:
Originally Posted by lapka
I wonder how does it work.... I mean is your health insurance paying for everything? For part of the rehab? Do you have to go to a certain rehab program or can you choose whatever you can find (in USA)? Or can you include other countries as well?
My personal experience is that dealing with all that organizational stuff around a health issue is as almost big nightmare like the health issue in itself.
Basically we can choose whatever we want, among the options they will pay for which may include asking them for something unique. They will not pay for anything outside the US. It can be somewhat challenging to get them to pay for something outside our state, lol.
In wife's case, the actual health issue is so complex that the organizational seems easy. Since everything goes through the brainstem, she can present pretty much any symptom at any time for any duration and it may mean something, or it may mean absolutely nothing. We have to be especially careful about going to doctors, just due to their tendency to want to "do" something.
She has been declared disabled and gets a basic income from Social Security and medical coverage through Medicare--specifically enrolled in a Medicare/Private partnership policy called an "Advantage" plan which we pay an overall lowish premium for and winds up working like a typical American "through-work" plan. We have a deductible then standard copays/percentages on approved care until we hit an out-of-pocket maximum at which point it is covered 100%, so long as the insurance company approves. Due to the Medicare/Disability angle and the fact we are working with facilities oriented toward long-term recovery, we've thus far had very good success at getting care approved, fingers crossed.
Where it gets really frustrating is when it comes to specific rehab therapy interventions; insurance approval really lags behind the science. There are useful therapies which the insurance will not pay for (even in a facility they have in-network) and there are *useless* and even disproven therapies which they will pay for. Part of the reason I don't want to take her to just any nearby clinic is to avoid money-making wastes of time, which I know has come up in the past.
Frequently, insurance may pay for two or even three months of continuous 2x/wk rehab therapy. Last year we received ten months, mostly of 3x per week. Have not tried to get more this year because we'd rather travel to a more expert facility in a larger city for a while, were making progress working the home-program our therapists had taught her, and she was sick of the 1 hr drive to rehab plus the workload she'd done there hadn't been challenging for a while anyway. The yoga is not covered at all. The caretaker who comes in a few afternoons per week is not covered at all. Some medical equipment and supplies are covered, some that are convenient or useful are not.
Sorry if I'm rambling--it happens.