Follow-Up Care and Insurance Company Clearance

[Guest guest]

While we're on the subject of insurance companies -- when I was ready to leave the hospital for the inpatient PT facility after having both knees replaced at the same time, my insurance company said that it wasn't covered. Fortunately, my insurance company was the same one used by the hospital for its employees. The hospital's benefits administrator got on the phone and told the rep to go back and read the coverage again.

Also, be careful what the therapists write about you on your chart. I thought I was really tough in the hospital. Of course, that's when I was on the hard pain killers. I wanted to bend further and walk further than anyone. My physical therapist and I bonded. She wrote I had a great attitude, was really coming along well. Based on that, the insurance company again tried to nix my move to the inpatient facility. My poor PT was devastated. My doctor -- who had never sent a double knee replacement straight home without a stay at the inpatient facility -- got on the phone and said no way would he release me to go home.

Then, the insurance company tried to kick me out of inpatient therapy after three days when the occupational therapist wrote something simple like I could pull on a pair of sweat pants, therefore could dress myself. The case worker got on the phone and convinced the insurance company I needed to stay the entire week. And I did need to stay. I had no one at my house. I couldn't even imagine getting in a car at that point.

So, though you're doing your best, don't let the therapists get too glowing with their reports. That's all some insurance companies need to deny further PT or OT treatment, whether it's inpatient or outpatient. I was told the insurance reps are not versed in medicine. They say no to further care and then sit back to see what happens. You have to have your doctor, physical therapist and occupational therapist in your corner, insisting you get the treatment you need.