Perhaps you have spent a long time in the hospital or have recently had surgery or another medical procedure. Your doctor may have prescribed skilled nursing rehabilitation to help you recover and get back on your feet. If your insurance company issues a skilled nursing rehabilitation denial, it can leave you feeling defeated and hopeless. How will you manage on your own? How will you get better if you do not have any assistance? Inpatient skilled nursing rehabilitation has a 70 percent discharge to community rate, proving it is a successful therapy.
This can be a scary time in your life and having help from an experienced insurance denial attorney who routinely fights for people in the same position can help you get through it in the best way possible. Attorney Scott Glovsky is ready to help you get the rehabilitative therapies you need by fighting for your rights and your future.
What is Skilled Nursing Rehabilitation?
Skilled nursing rehabilitation provides services to those recovering from hospital stays. These can include physical therapy, occupational therapy, speech therapy, social and psychological programs, and specialized rehab therapies like orthopedic, respiratory, and cardiac. Skilled nursing rehab therapies can last for one to two hours per day.
During that time, the patient may also receive assistance with daily living tasks, including eating, bathing, and using the restroom. Staff who work for skilled nursing rehabilitation can include nursing assistants, licensed practical nurses, registered nurses, and physical, occupational, and speech therapists. The patient’s health and rehab goals will be evaluated, and a care plan developed.
What Types of Treatment Can Skilled Nursing Facilities Provide?
Depending on the patient’s needs, skilled nursing services may include any combination of the following:
- Assistance with daily living activities
- Wound care to help prevent infections
- Nutrition therapy, providing healthy meals for patients
- Cardiac care for those with heart health issues
- Post-stroke recovery including restoring mobility and speech
- Pulmonary rehab for those with poor lung function
- Physical therapy exercise to provide pain relief and restore balance and mobility
- Speech therapy to provide cognition, communication, and swallowing assistance
- Occupational therapy to help patients overcome physical challenges
What Ailments Are Typically Treated in a Skilled Nursing Rehabilitation?
When people go home directly from the hospital, they often need skilled nursing rehabilitation to help them recover from surgery or other medical procedures. Skilled nursing rehabilitation can also help patients learn to safely use a cane, walker, crutches, or wheelchair and to get in and out of bed on their own. Patients will learn how to move between rooms in their homes, and to go up and down stairs if they are unavoidable.
Medical issues like diabetes, lung problems, and heart problems that are not well-controlled are among the ailments that can require skilled nursing rehabilitation services. Those who undergo joint replacement surgery, have spent a long time in the hospital, or who have had a stroke or other brain injury can benefit from skilled nursing rehabilitation. If a patient takes medications that cannot be safely given at home or has surgical wounds that need regular care, skilled nursing rehabilitation can help.
Why You Might Receive a Skilled Nursing Rehab Denial?
Skilled nursing rehabilitation therapy can cost upwards of $300 per day, which is why some insurers may deny the charges. If you receive a skilled nursing rehab denial, it is important that you file an internal appeal to ask your insurance company to reconsider its original decision.
The letter you receive from your insurer should give a reason for the denial, which could include saying skilled nursing rehab is not medically necessary. You may have letters from your doctor or doctors that explain in detail how skilled nursing rehabilitative therapies can help you get better and help you learn to take care of yourself.
If your internal appeal does not result in approval for your skilled nursing rehabilitation, your attorney can help you file an external appeal. The external appeal asks a third party to take a look at the denial from your insurance company and make a decision as to whether the insurer should pay for skilled nursing rehabilitation.
Which Insurers Are Most Likely to Issue a Skilled Nursing Rehab Denial?
Any insurer can issue a denial. They may say that the service, test, or prescription drug is not medically necessary or that it is “experimental,” or “investigational.” California insurers who may deny your request for skilled nursing rehabilitation services include:
How the Law Offices of Scott Glovsky Can Help with a Skilled Nursing Rehab Denial
Attorney Scott Glovsky formerly worked in large corporate law firms defending big insurance companies in bad faith lawsuits. This means he has a deep understanding of how these companies think and operate and can stay one step ahead of their denial strategies. When you choose the Law Offices of Scott Glovsky, you have chosen an attorney with a solid legal team and a mission to help those who have been wronged. Scott and his team really care about each client and will support you and be responsive to your needs. Contact the Law Offices of Scott Glovsky today to get the assistance you need.