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.

Stroke Connection. Get the app for free.


- Advertisement -

This link is provided for convenience only and is not an endorsement or recommendation of either the linked-to entity or any product or service.

AD. Amramp Making Life Accessible. 20 years. Be accessible to everyone. Protect your clients & their caregivers from slip and fall accidents. 888-715-7599. Click here for more info.

AD: American Stroke Association-American Heart Association logo. Did you know that about 1 in 4 stroke survivors have a second stroke? Learn more.


Ad: American Heart Association logo. American Diabetes Associaiton logo. Know diabetes by heart logo. Living with diabetes? Inspire others. Submit story button.


AD. American Heart Association logo. Know your blood pressure numbers. And what they mean. Gain Control.  Learn more.


Ad: American Heart Association Support Network. Facing recovery after a stroke or heart disease diagnosis can be overwhelming. You are not alone. Our community is here for you. Join us today.


Edit ModuleShow Tags

Stroke Rehabilitation

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 from Outpatient Rehab

After stroke, about two-thirds of survivors receive some type of rehabilitation. Outpatient therapy may consist of Several types of therapy. Whether a patient is referred to inpatient or outpatient therapy depends on the level of medical care required.

What to Expect in Stroke Rehab

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

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.

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.

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

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 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.
Edit ModuleShow Tags

Stroke & Parts of the Brain

When Stroke Affects the Occipital Lobe

Our occipital lobe, the smallest of the four lobes of the cerebral cortex, controls how we visually interpret our world.

When Stroke Affects the Cerebellum

The cerebellum contains 80 percent of our neurons. Its job seems to be to make things better. We talked with neuroscientist Jeremy Schmahmann about how stroke affects the “little brain.”

When Stroke Affects the Parietal Lobe

The parietal lobe helps us make sense of sensory information, like where our bodies and body parts are in space, our sense of touch, and the part of our vision that deals with the location of objects.

When Stroke Affects the Frontal Lobe

Of the four lobes that make up the cerebral cortex, the frontal lobe is the largest. It plays a huge role in many of the functions that make us human — memory, language, movement, judgment, abstract thinking.

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.
Edit ModuleShow Tags


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.

Helping Others Understand

Stroke affects people differently and many of the effects of stroke can be complicated. Helping friends and family understand how a stroke is affecting a survivor can help everyone involved.

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!