Rehabilitative Services
Recovery from illness, injury, or surgery often requires specialized rehabilitation. Our plans cover a full range of rehab services to help you regain independence and quality of life.
Recovery from illness, injury, or surgery often requires specialized rehabilitation. Our plans cover a full range of rehab services to help you regain independence and quality of life.
When serious illness, major surgery, or significant injury disrupts your life, rehabilitation services are often the key to regaining function and independence. Rehabilitation goes beyond treating the immediate medical problem to help you recover the ability to perform daily activities, return to work, and maintain quality of life. Without proper rehabilitation, many patients never fully recover from major health events.
The Affordable Care Act recognizes rehabilitative services as one of the ten essential health benefits that all comprehensive health plans must cover. This includes physical therapy, occupational therapy, speech therapy, and other services needed to restore function after illness or injury. Rehabilitation is not a luxury but a medically necessary part of recovery.
Our health insurance plans provide comprehensive coverage for rehabilitative services across all settings, from inpatient rehabilitation hospitals to outpatient therapy clinics to home-based services. Whether you're recovering from a stroke, heart attack, major surgery, or traumatic injury, our coverage ensures access to the rehabilitation services you need for the best possible recovery.
Restore strength, mobility, balance, and physical function after injury, surgery, or illness. Physical therapists develop customized exercise programs targeting your specific functional limitations and recovery goals.
Relearn daily living skills like dressing, bathing, cooking, and working. Occupational therapists help you adapt activities and environments to maximize independence despite physical or cognitive limitations.
Treatment for speech, language, voice, and swallowing disorders resulting from stroke, brain injury, cancer treatment, or neurological conditions. Speech-language pathologists help restore communication abilities.
Therapy for memory, attention, problem-solving, and executive function impairments after brain injury, stroke, or neurological disease. Helps restore mental abilities needed for daily function.
Supervised exercise training, education, and counseling after heart attack, heart surgery, or heart failure diagnosis. Cardiac rehab significantly improves outcomes and reduces future cardiac events.
Intensive rehabilitation in a specialized hospital unit or freestanding rehabilitation facility. Provides multiple hours of therapy daily with 24-hour nursing care for patients who need intensive support.
Specialized facilities providing intensive rehabilitation with at least 3 hours of therapy daily, 5-7 days per week. Appropriate for patients recovering from major stroke, brain injury, spinal cord injury, amputation, or multiple trauma who need 24-hour medical supervision.
Rehabilitation services provided in a nursing facility setting for patients who need daily skilled care but not the intensity of inpatient rehab. Often used as a step-down from hospital care or for older adults who need more support than outpatient therapy can provide.
Therapy services provided at clinics, hospitals, or private practices while you live at home. Most rehabilitation occurs in outpatient settings, with patients attending 2-3 sessions per week. Allows you to maintain daily routines while receiving treatment.
Therapy services delivered in your home by licensed therapists. Appropriate when leaving home is difficult or when therapy needs to focus on functioning in your actual living environment. Often used during early recovery or for homebound patients.
Rehabilitation coverage can be complex, involving different benefits depending on the setting and type of therapy. Here's what you need to know:
Rehabilitation services must be medically necessary and ordered by a physician. Coverage continues as long as you're making measurable progress toward your therapy goals. Your rehabilitation team documents your progress to support continued coverage.
Inpatient rehabilitation typically requires prior authorization from your insurance company. Your hospital discharge planner or case manager coordinates this process. Outpatient therapy may not require prior authorization but some plans do require it after a certain number of visits.
Some plans have combined annual limits for physical, occupational, and speech therapy (e.g., 60 combined visits). Others have separate limits for each therapy type. Understanding your plan's structure helps you and your therapy team plan treatment appropriately.
Rehabilitative services restore function you previously had. Habilitative services help develop skills you never had (often for children with developmental conditions). Both are covered, but they may have different benefit structures.
Duration varies widely depending on your condition and goals. A minor injury might need 4-6 weeks of outpatient therapy. Stroke or brain injury rehabilitation can continue for months or even years. Your therapy team sets realistic goals and adjusts treatment as you progress.
Physical therapy focuses on movement, strength, balance, and mobility like walking or climbing stairs. Occupational therapy focuses on daily living activities like dressing, bathing, eating, and job tasks. Many patients benefit from both types of therapy working together.
Most surgical patients recover well with outpatient therapy. Inpatient rehabilitation is typically reserved for patients who need intensive daily therapy and can't safely manage at home, such as after major stroke, brain surgery, or bilateral joint replacement.
Yes, cardiac rehabilitation is one of the most effective treatments after heart events. Studies show cardiac rehab reduces mortality by 20-30%, decreases hospital readmissions, and significantly improves quality of life. Despite its effectiveness, it remains underutilized. Don't skip it.
If therapy is denied, you have the right to appeal. Your therapist can provide documentation supporting medical necessity. Many denials are overturned on appeal. You can also ask for a peer-to-peer review where your doctor speaks directly with the insurance company's medical reviewer.
Quality rehabilitation makes the difference between partial recovery and getting back to your best possible function. Don't let insurance concerns prevent you from completing the rehabilitation you need. Speak with a licensed agent today about plans with comprehensive rehabilitative coverage.