Reply to Medicare appeals for further PT

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[quote=Anonymous]Are they now better able to engage in PT and work toward reachable rehab goals? Is so, I’d appeal again. I’ve never seen a successful appeal at the hospital level but the cases have not been as strong as what you describe here (which sounds like a change in status/functionality?).

Are you trying to extend their rehab stay/prevent them from going home, or do they now reside in the nursing home? If the latter, another option (which is expensive) is to hire their in-house PT for a few sessions and then have them train family to assist in exercises that can be safely performed seated or at bedside.

But I’m surprised that the rehab team is not on board with re-attempting PT now that the UTI is treated. It’s possible that they didn’t want to administer pain meds before therapy due to potential drowsiness/risk for falls - I’m wondering what they gave communicated to you.

If your parent is going home, Medicare will cover the cost of home PT and again, family/caregivers can be trained to assist, if possible.

But if Levanta already denied your appeal, I would be prepared for another denial. When you call to appeal, ask them what your options are and how you can best advocate for your parent, because the company that manages appeals is an outside agency that is unaffiliated with Medicare.

Good luck.[/quote]

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