Outpatient therapy is designed for those needing continued physical, occupation, or speech therapy but do not need an inpatient level of care. Patients are typically referred by a physician but may self-refer if paying out of pocket. The goal of outpatient therapy is to assist the patient in returning to prior level. This is typically done at an outpatient facility or gym and can be associated with a hospital or free standing. This service is typically offered after a hospital stay or Home Health discharge when a patient is able to travel to the facility, however in some cases Home Health Agencies can provide this service in the home even after that patient is no longer home bound.
Average Length of Stay
The length of time services will be provided depends on the individual needs of the patient and the prior authorization of the insurance. Patients are typically approved for a set amount of visits per authorization and more visits will be requested by the therapist if needed.
Who pays for it
Outpatient services are typically covered by Medicare, AHCCCS, Medicare Advantage plans, and private insurance but a patient can self-pay as well. There may be a set amount of dollars available per year for outpatient therapy. Patients will usually be responsible for a co-pay for each visit so it’s important to understand your insurance benefits prior to starting with an Outpatient Therapy program. Veterans enrolled in the VA may have coverage for Outpatient therapy at a VHA medical facility.
What I should know
If additional visits past the initial authorized amount are needed for continued therapy, the therapist will need to make a request to the insurance provider. There may be a delay in services while the request is either approved or denied.
Expect for the therapist to provide a list of exercises the patient will need to do on their own in between visits. These exercises will be crucial to the recovery process.
Where do I go from here?
From an outpatient therapy program a person will typically discharge with no additional services. It is possible for a person to be referred to home health or hospice at this point, however this is not typical.