If you or a loved one are contemplating inpatient rehab treatment for physical or behavioral health, you will be considered a resident at the facility you and your health care provider choose. Your doctor will order your admission, and nurses at the rehab hospital will help prepare paperwork for your admission or transfer.
Significance
If you have substance abuse problems, surgery or another condition that requires direct help from psychological, physical and occupational therapists, nurses and social workers to regain your ability to function, your doctor may order care for you at a rehab hospital. There are two types of facilities: One provides services to patients who need extra time to recover after a stay in an acute care hospital. For example, rehab hospitals treat patients after strokes, amputations, brain injuries, spinal cord injuries and surgery.
The other types of rehab hospitals treat patients with substance abuse and behavioral problems, including major depression, bipolar or anxiety disorder, schizophrenia or Alzheimer's disease. These hospitals offer both in and outpatient treatment.
Considerations
If you have insurance coverage through an HMO, Medicare, Medicaid, workers' compensation or a fee-for-service insurance plan, your stay in a rehab hospital will be covered as long as it is medically necessary. This concept applies to care for physical and substance abuse issues. Your doctor and the doctors treating you at the rehab hospital will determine the amount of time you will need treatment. You may be in the rehab facility from a few days to a several weeks, depending on your diagnosis.
Admission Policies
Because rehab hospitals do not treat you if you have an acute or emergent injury, they must certify the need for your admission before transfer from your local hospital. Once you have healed adequately, recovered from an acute behavioral health issues or substance withdrawal, and your condition has stabilized, you may be transferred to a rehab facility for your therapy and care. If you become acutely ill while you are there, you may be transferred back to your original hospital. If you are entering rehab for chronic substance abuse, and you are not in crisis, you may be admitted directly after you have participated in a pre-admission evaluation.
Once your doctor determines your need for inpatient rehab services, he will work with other hospital employees to certify the medical necessity of your rehab care.
Rehab Assessment Policies and Procedures
While you are at the rehab hospital, the doctor, nurses and therapists will be assessing your progress with therapy. They will be measuring and recording your progress. The interventions that have been built into your plan of care will be reviewed regularly to be sure they are meeting your recovery needs. If you are in rehab for physical recovery, your care team will be monitoring your improved strength, gait, and use of any affected limbs, to name a few. Improvements in your daily living activities, attitude, community interactions and drug-seeking behavior will be monitored if you are in rehab for behavioral health or substance abuse recovery. Your therapy is designed to improve your ability to function as well as possible. Your doctor and the rehab hospital team will determine when you have adequately met your goals and are ready for discharge. Additional rehab may be recommended on an outpatient basis.
Tip
You may be planning elective surgery such as knee replacement, and know in advance that you will need rehab care. Perhaps you are considering rehab for yourself or a loved one with a substance abuse problem. In either case, contact your health plan to determine what is necessary to certify your stay in the rehab facility before you are admitted. Call members' services and work with your doctor and the facility's admissions staff to accomplish this. You or your doctor may need to provide a copy of your medical records to the insurance company so your stay will be reimbursed correctly.
