Getting the Most Therapy Coverage




Stroke survivors can almost always benefit from more therapy (physical, speech, occupational), but most insurers limit the amount of therapy coverage. Getting more therapy is not as simple as asking nicely. You must understand your insurance benefits and discuss them knowledgeably with your insurer, their Utilization Review Nurse (URN) and your rehab provider.

Maximizing Your Rehab and Recovery

Since rehabilitation coverage is limited, make sure you maximize your therapy while you have good insurance coverage. Here are some considerations to maximize your therapy:

  • Work hard to continue the best outcomes. If you’re making progress in therapy, you may be able to continue if you get authorization from your insurance provider. Authorization is only granted when consistent progress has been achieved and documented by your rehab provider. Discuss your progress with your therapy team and follow your treatment plan. Compliance can affect your progress. Always ask for copies of the documentation.
  • Ask your therapist for a home plan. A home therapy plan often helps maximize your results and therapy. Stroke recovery is a lifelong effort. Diligence in working on home rehabilitation is important.
  • If you can afford it, consider out-of-pocket rehabilitation to continue your therapy. Some insurance companies have a set dollar amount for rehabilitation therapy. If you’re in therapy and you want to continue past your policy’s cutoff, talk to your therapist and doctor and expect out-of pocket costs.
  • Be proactive if you’re not meeting your goals. If you believe your rehab is inadequate, talk to your doctor about transferring to a new provider.

A Change in Your Condition

If you’re not in therapy, but have noticed a change — positive or negative — in mobility or speech, talk to your doctor about getting more therapy. Your doctor must validate changes in your condition and prescribe additional rehab — if it’s medically necessary. Medical necessity must meet one of these standards:

  • The service is expected to prevent the onset of an illness, condition or disability.
  • The service is expected to reduce the physical, mental or developmental effects of an illness, condition or disability.
  • The service will help the person achieve or maintain maximum functional capacity in performing daily activities.

Once rehab is authorized, you may participate until maximum medical improvement has been achieved. Services stop when progress stops. Again, make sure your provider is documenting your progress and ask for a copy. Whenever you or your caregiver see a change in your functional ability, get re-evaluated by your rehab doctor or therapist. Functional abilities include selfcare skills such as feeding, dressing and grooming as well as transfers, walking and wheelchair skills. If your caregiver is having more difficulty helping you, that may meet the standard for more therapy.

Work with Your Insurer’s Review Nurse

Create an ally in your Utilization Review Nurse, who works for your insurance company to control overuse of services, reduce costs and manage care. The URN reviews bills and records and discusses your case with your provider. That’s why documentation is so important.

Insurers follow protocols to determine overuse of care. An insurer may refuse to reimburse for services when they don’t meet those standards. Your URN will know and understand those protocols. He or she may determine other areas of your policy that can cover services once the rehab portion is used up. Insurers make exceptions under specific circumstances. URNs know the rules. They can guide you in getting the right documentation.

Source: Excerpted and adapted from the American Stroke Association’s Finances After Stroke Guide, free downloadable PDF available.

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Stroke Rehabilitation Two-Part Series

Making the Best Decisions at Discharge After Stroke

The type of rehabilitation and support systems a survivor receives at discharge can strongly influence health outcomes and recovery. In this, the first part of a two-part series on stroke rehab, we offer guidance for the decision-making process required when it’s time to leave the hospital.

What to Expect in Stroke Rehab

Following a stroke, about two-thirds of survivors receive some type rehabilitation. In this second of our two-art series, we want to alleviate some of the mystery, fear and anxiety around the inpatient rehab part of the stroke recovery journey.
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AHA-ASA Resources

The Support Network

When faced with challenges recovering from heart disease or stroke, it’s important to have emotional support. That is why we created a network to connect patients and loved ones with others during their journey.

Stroke Family Warmline

The Warmline connects stroke survivors and their families with an ASA team member who can provide support, helpful information or just a listening ear.

Let's Talk About Stroke Patient Information Sheets

Let's Talk About Stroke is a series of downloadable patient information sheets, created by the American Stroke Association, that presents information in a question-and-answer format that's brief, easy to follow and easy to read.

Request Free Stroke Information Packets

Fill out this online form to request free information about a variety of post-stroke topics.

Caregiver Guide to Stroke

The Caregiver Guide to Stroke is meant to help caregivers better navigate the recovery process and the financial and social implications of a stroke.

Tips for Daily Living Library

This volunteer-powered library gathers tips and ideas from stroke survivors, caregivers and healthcare professionals all over the country who’ve created or discovered adaptive and often innovative ways to get things done!

Stroke Support Group Finder

To find a group near you, simply enter your ZIP code and a mile radius. If your initial search does not pull up any groups, try
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Stroke & Parts of the Brain

When Stroke Affects the Temporal Lobe

The temporal lobe has several functions, mainly involved with memory, perception and language.

When Stroke Affects the Brain Stem

The brain stem serves as a bridge in the nervous system. It sits at the top of the spinal column in the center of the brain. When a stroke happens there, it can cause a few different deficits and, in the most severe cases, can lead to locked-in syndrome.

When Stroke Affects the Thalamus

The thalamus can be thought of as a "relay station," receiving signals from the brain’s outer regions (cerebral cortex), interpreting them, then sending them to other areas of the brain to complete their job.
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Departments

Stroke Notes

Stroke-related news you can use about new scientific findings, public policy, programs and resources.

Readers Room

Articles, poems and art submitted by stroke survivors and their loved ones.

Life Is Why

Everyone has a reason to live a longer, healthier life. These stroke survivors, caregivers and others share their 'whys'. We'd love for you to share yours, too!

Everyday Survival

Practical tips and advice for day-to day living after stroke.

Life At The Curb

A unique perspective on survival by comedian and stroke survivor John Kawie.

Simple Cooking

Cooking at home can be a daunting task, but a rewarding one for your diet and lifestyle (and your wallet). Making small changes in your diet is important to your heart health. Here are simple, healthy and affordable recipes and cooking tips.

Support Showcase

Our new department highlighting the good work being done by stroke support groups from around the nation. If you are part of a successful support group we should consider featuring, let us know!