Q: Recently my husband had a stroke and required therapy. I was surprised that his treatment included different types of therapists. Can you explain the different types of therapy?
A: That is a very good question. I’m sure many of us are a bit confused about the services of different health care providers.
Generally you will encounter three types of therapists: physical therapists, occupational therapists and speech or language therapists. Depending on a person’s disability his or her therapy may involve just one type of therapist or may include the services of all three.
Physical therapy is needed when the patient has lost muscle strength, has lost the ability to move or has restricted range of motion. Treatment that strengthens muscles and improves coordination includes use of exercise programs as well as heat or cold applications or water therapy.
Occupational therapy is needed when a patient’s handicap hinders his or her ability in dealing with daily living activities. Treatment again includes exercise routines and heat or cold applications and whirlpool treatments as well as the use of adaptive equipment that helps improve function and independence.
Speech therapy deals with speech, language and voice problems. Depending upon the type of disability, speech therapists teach new communication skills, proper breathing and voice projection techniques as well as relearning speech and techniques for improving memory.
Q: I am currently receiving in-home health care under Medicare coverage. I’m concerned about the possibility of services being denied. If that happens what options do I have?
A: If your home health agency thinks that Medicare will stop paying for your home health care they must give you a notice, known as an Advance Beneficiary Notice, that explains why and when they think payment will be denied.
When you receive such notice and you feel you still need that home health care and that Medicare should continue to pay for it you can ask for an official decision.
To get an official decision you must do several things. You must continue receiving home health care. Ask how much that care will cost and understand that you may have to pay the agency for those services. Then request the home health care agency send your claim to Medicare for their review.
If Medicare determines your coverage should continue you will be reimbursed for any payment you made minus any co-insurance for durable medical equipment, if appropriate. If the official decision is still a denial of services you then have the right to appeal that decision.
If the question is about Medicare denying payment for a specific item or services that you feel should be covered as part of your home health care you can file an appeal. When filing such an appeal ask your doctor or provider for any information related to that item or service that would help strengthen your claim.
