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Sunday, November 18, 2012

Progress at Rehab! But...

Don't you just hate that word: "but..."?

When Bob started Outpatient Rehab back in August, he couldn't stand at the parallel bars without two therapists holding him up in a big bear hug, like this

Bob at the parallel bars in August

Plus, he could not hold his head up at all and was leaning horribly to the left.

First time with the hemi-walker.

Since then, he has gradually progressed to working with one single therapist.

The first time up on the hemi-walker, he was literally falling over backward and the therapist was holding him up like this:

This past week, Bob had another 4 week evaluation. At that time, he was able to walk 160 feet at the parallel bars unassisted and without hardly leaning to the left at all. And he stood with the hemi-walker for a total of 1 minute and 30 seconds unassisted. And the therapist measured his head drop which has improved dramatically by several degrees and he is now able to hold his head up for the count of 15 in a perfectly "neutral" position unassisted....

The therapists say they are very pleased with his progress, but.... (there's that damn word, but..)

But they are telling me that the insurance will not pay for more than 30 sessions of therapy, and next Tuesday will be Session Number 30. So they are preparing to discharge him.

So I asked if there was any way around this, because, according to Bob's medicare plan, therapy is "unlimited" as long as it's "medically necessary". But (there's that word again) I am told that even so, after 30 sessions this insurance company will scrutinize the progress Bob has made and because he has not become truly "functional" (another word I hate) they may actually go back and deny coverage of past sessions. And, of course, the PT was very very sorry about all this, but that's the way the system works and they, the Outpatient Rehab Center, cannot take the chance of having past sessions not covered by the insurance. 

The PT did say she felt very bad especially since she knew how motivated Bob was in his therapy and how very well he was doing, so she asked the Management if it would be at all possible if I could bring Bob to their Rehab Center so that he could work on the equipment without a therapist. She didn't know if this was possible, probably not because of liability issues, but she did ask and was waiting to hear an answer.

Of course, you can imagine how I felt hearing all this. And how Bob felt, after trying so long and hard. And of course, we cannot afford to pay out-of-pocket for continued therapy.

So I stood there watching the PT work with Bob, and I had an idea. 

I asked her if I could get some more financial aid from the hospital's charity foundation which is already paying Bob's therapy co-pays, if they would agree to pay the whole cost of the therapy sessions, would the Rehab Center be willing to continue the therapy?

And she said, yes. Of course, because they are very pleased with his progress.

So on Friday I called the hospital's financial assistance office and explained the situation to the supervisor there, and she is going to request a "review packet" of Bob's chart from the Rehab Center and then bring the proposal up to the charity foundation board and she'll let me know what they decide. Oh, I do hate to beg for help, but this girl's gotta do what she's gotta do.

So fingers crossed, prayers needed, and maybe, just maybe the board will approve it, and I'll be able to keep him going to therapy. 

If not, I don't know what we will do...  

Honest-to-God, I don't know if Bob will ever be able to take a step with that walker as he is very unstable, but I want to give him the chance and time to try---and I don't think it's something we could safely practice on our own at home with all of his balance issues.


Anonymous said...

Fingers and toes crossed for the Review Board to Approve
I know how important that extra bit of therapy is
Thoughts ,prayers, and hopes with you

Kelsae said...

Oh goodness, I hope the board approves the extra therapy sessions.

I've just spent the last two weeks feeling sorry for myself because our insurance company is leaning on the rehab doctors to discharge my husband from his outpatient therapy. It happens to so many survivors - damn this long-term recovery and "functional improvement" nonsense.

You've inspired me to be more creative in finding a solution to my insurance woes. I won't let Mike's insurance determine our ability to get him help.

barbpolan said...

Wow, what a leap! It's hard to believe that being able to stand and/or use the walker is not considered "functional." What would have been considered functional as improvement from Bob's August condition? How far was he supposed to get?

Kudos to you for continuing on despite every roadblock in your - and Bob's - way. I am very impressed that you are so creative and persistent in your problem-solving.
I often think of you and Bob tackling your challenges so graciously.

Anonymous said...

I know how hard you've fought for everything to improve Bob's abilities. Though there may be a liability problem with the PT office, I do wonder if you could sign a liability release of some kind to release them of any possible damages so that you can continue to use the facility with Bob?
Adding to the prayers and hopes that the financial assistance is forth coming with approval, or that insurance can continue. Hugs, Dan

Rebecca Dutton said...

Bob may never be able to walk several feet BUT if he can stand up so you are not lifting his entire weight and take tiny steps to pivot in a circle or cross any small gaps will make transfers safer for him AND you. Insurance companies pay attention to the word safety. Safety of the caregiver is functional!

Grace Carpenter said...

I'm so mad about your situation I couldn't even write for a while. The first thing is:PT--when all is said and done--is a bargain. It's non-invasive, and so cheap compared to the alternatives, e.g. letting a person get worse, until you *have* to use radical (and expensive) measures. I could go on and on...

In solidarity,