What can you do when insurance discontinues physical therapy because a patient is not making enough progress?

Jeanniegibbs is right on as she so often is. You can discuss this with the doctor and if he or she thinks more progress can be made, then try the appeal process. She could also try to see an alternative therapy doctor who may recommend acupuncture or other therapies such as guided yoga that few physical therapists will refer you to. Be sure to see someone who is respected in the community if you do this. There are people who will promise the world. You want someone to honestly tell you if there are other therapies can help.
Second opinions can be valuable, as well, from any type of doctor. You friend is young to accept a lesser quality of life without looking into alternatives.
Good luck,
Carol

I guess the thinking is that there is no point in continuing the discomfort, effort, and expense of physical therapy is it is not helping. Does her sister (or you) think that she was making progress, or that something has changed that might enable her to make more progress now (such as that she is more alert now)? I think I would call the insurance company and see what the appeal process is. Usually that information is included in any correspondence from the insurance company.

Or is it that you and the sister are wondering what else can be done for your friend? If physical therapy isn't likely to help, what is? I think that needs to be discussed with her doctor.

This happened with my father. Medicare said they would only pay for PT if it was possible to restore function and they deemed it was not possible based on what the physical therapist at AL was telling them. You need to get the medical records that have been provided to Medicare. My stepmother brought in another physical therapist, paying out of pocket to get a second assessment, and was able to get the decision changed and my father was able to walk again. Good luck to you!

When my mother-in-law broke her hip and had to go into rehab, Kaiser insurance told us they were going to stop paying as soon as she stopped making progress. I think that's status-quot for insurance companies. In her case I pushed her a little harder because she was able to do more so they did continue to pay for another week or so. But that was it then.

what is the appeal process for medicare. My 92 year old father is in a rehab - went in after a few weeks in the hospital as a result of a UTI. Was crazy/out of control when he entered the rehab I guess from the UTI, they were giving him antipsychotic meds and sedatives - adjusting the dose. Also he seems to have mild dementia. He is more stable now. PT was stopped a few weeks ago because the therapist felt his cognitive abilities were hampering his progress - there was no carry over from day to day.

I would like to attempt an appeal. What is involved in the process? I was told you have 30 days to appeal. I only have 10 days till that window closes.