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insurance
My mother has pulmonary fibrosis from a drug or ILD
She recently had pneumonia. Prior to pneumonia she was not on oxygenShe attended pulm rehab once prior
They are only giving her 16 visit. It seems like more should be granted since she just had pneumonia and has pulmonary fibrosis
Can anyone help me with this re: insurance and visits?
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9 Replies
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Hi, what kind of insurance does she have? If Medicare, then I can speak to that. If an Advantage plan then I don’t know anything. Let me know and I’ll answer back!
Blessings, Scherry
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She has Medicare and a supplemental plan
She used 18 visits in 2023, and they are only giving her 16 more visits currently
she is on visit 14 tomorrow. Medicare keeps saying 36 visits for start then 36 more can be approved if necessary. They say for a lifetime max of 72 visits Is this true?
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Hi Vickii,
In addition to what Scherry replied, I recommend you speak with the folks in pulmonary rehabilitation and your mother’s care team. There are so many reasons for pulmonary rehabilitation that can be coded for insurance to make it work. Talk with the team about your concerns and what benefits you think additional sessions would provide.
Sam…
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Hi Vicki!
I agree with Sam; I’m actually in the middle of pulmonary rehab myself and initially Medicare agreed to only 16 sessions. My RT was able to get them to agree to 36 when I hit session 14.
Rehab has been a miracle for me; I have been able to increase my activity while reducing the amount of o2 to do it. This certainly wasn’t the case before I started. Please ask the RT to appeal if she was denied more sessions, but a phone call or recoding as Sam suggested, may be all you need.
Good luck!
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I have the original Medicare and my initial 26 visits were covered. After that the Therapist requested 26 more. Those visits were completely covered. Now I pay a small monthly fee to attend. I have gone for over 3 years now.
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Hi Mary
Is that for Pulmonary Rehab phase one and phase two?
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Where I attend there aren’t any different phases.
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Thank you for responding
Medicare says only 36 and 36 more if justified- a total of 72 visits a lifetime
has anyone gotten approval from Medicare for over and above the above visit number of 72?
Thanks Vicki
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my mom used 18 last pulm rehab two years ago
Now 16 they mentioned they would give her-
Possibly I should have the Pulmonary Dr write a letter and
a prescription to the Pulmonary rehab facility to extend her program 4 weeks
The facility is very stingy on the visits
I believe 72 is the lifetime limit
Can someone give me some guidance?
Thanks so much
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