topic Re: In-Home PT with Medicare in Medicare & Insurance

In-Home PT with Medicare

cm46616293 — Thu, 19 Dec 2024 15:48:55 GMT

Apologies if this posts twice, first one "authentication failed."

My 91 year old mother-in-law lives in an independent living facility near us. She is having a partial knee replacement in January. She needs a cane or walker to get around and can walk up one step, maximum. She does not have a driver's license. Talking with the doctor's nurse yesterday, I was informed that she is ineligible to receive home physical therapy after surgery (but will need PT 3 times a week for 6 to 8 weeks). The nurse said that: not driving is not a criterion, she can take a ride share; this is elective surgery so she can't have in-home PT; she "does not qualify for that level of ". I looked at the Medicare handbook, as did she, and we are interpreting this differently! Also just had a friend with a knee surgery get in-home PT so not sure what to do next! Any thoughts on how to pursue this? This is a well-known surgical center and I've had friends (younger) who have gone there with no problems; we like the doctor. Thanks. EDITED: she has original Medicare Parts A and B. I talked to a home health care provider who told me if it is "very taxing" for her to leave her home (it is), then she should be able to get in-home PT. I now have a message in to her PCM (a geriatric specialist) asking her about this. I can't call/message the ortho doc directly.

Re: In-Home PT with Medicare

TRL1111 — Thu, 19 Dec 2024 15:03:01 GMT

Original Medicare or Medicare Advantage? I'm not sure about home health care, but a lot of the controversial denials we're all hearing about are for skilled nursing care (in a facility, not at home) because Advantage plans have their own rules/guidelines/standards for that, and they're more restrictive than Original Medicare's rules. I wouldn't be surprised if Advantage plans have similar differences when it comes to home health care.

Re: In-Home PT with Medicare

cm46616293 — Thu, 19 Dec 2024 15:46:32 GMT

Original Medicare, Parts A and B. Reading from the 2024 handbook, p 44. Also talked to a home health care provider who said she should be able to get in-home PT if it is "very taxing" for her to leave home. It is. I now have a message in to her PCM to ask about this. Can't message the ortho doc directly, have to go thru the nurse (who said no).