Frustration with cognitve issues

[Marco]

its2much - it varies widely per insurance plan, but most do offer some therapy for rehab and chronic conditions. You still have one month to use them for this year. For whatever reason, my plan is better for out-of-network providers than in-network. Fortunately, I found a place willing to accept the out-of-network payment as payment in full. So I do not have a copay or anything for my therapy appointments.

I found this snippet about speech therapy from the Obamacare website:

Rehabilitative services and devices – Rehabilitative services (help recovering skills, like speech therapy after a stroke) and habilitative services (help developing skills, like speech therapy for children) and devices to help you gain or recover mental and physical skills lost to injury, disability or a chronic condition (this also includes devices needed for “habilitative reasons”). Plans have to provide 30 visits each year for either physical or occupational therapy, or visits to the chiropractor. Plans must also cover 30 visits for speech therapy as well as 30 visits for cardiac or pulmonary rehab.

http://obamacarefacts.com/essential-health-benefits/

This blurb is for Medicare.

Physical therapy/occupational therapy/speech-language pathology services

How often is it covered?

Medicare Part B (Medical Insurance) helps pay for medically necessary outpatient physical and occupational therapy, and speech-language pathology services. There are limits on these services when you get them from most outpatient providers. These limits are called “therapy caps” or "therapy cap limits."

The therapy cap limits for 2015 are:

• $1,940 for physical therapy (PT) and speech-language pathology (SLP) services combined
• $1,940 for occupational therapy (OT) services

You may qualify to get an exception to the therapy cap limits so that Medicare will continue to pay its share for your therapy services after you reach the therapy cap limits. Your therapist must:

• Document your need for medically reasonable and necessary services in your medical record
• Indicate on your Medicare claim for services above the therapy cap that your outpatient therapy services are medically reasonable and necessary
  

http://www.medicare.gov/coverage/pt-...pathology.html

[its2much]

Thanks Marco for the info

Neuro has also ordered physical therapy for gait and hands. I ourchase my own individual health insurance. There is absolutely NO out-of-network coverage...

[Marco]

For healthy people, insurance shopping is not that critical. For patients with chronic conditions, insurance shopping is a worthwhile experience. The insurance company was billed $6k for my wheelchair. Thankfully, it was a covered benefit based on my Durable Medical Equipment (DME) provider. A healthy person would never price out a wheelchair, but I was already using a rollator and heading downhill quickly.
I would also suggest you contact an insurance broker to help you navigate the options compared to your unique needs.

From my limited experience, the medicare website is much better than the obamacare website in accurately gauging your annual out-of-pocket expensesl One option was roughly $90k and another one was near $10k (don't recall). Can you guess which one I did not want?