Outpatient Services are appropriate for medically stable individuals who have shown the potential to measurably improve their functional abilities. A patient can be admitted to Outpatient Services when he or she has:
- A prescription for an evaluation from a licensed doctor
- Medical insurance on which therapy has been authorized or an ability to pay cash for the services rendered
Each patient is given an initial assessment. The length of the treatment depends on the type of injury or disorder and how much progress the patient makes during treatment. Each patient's progress is monitored monthly. Progress reports will be given to the referring doctor monthly or upon request. Discharge planning goes on throughout his or her course of therapy.
A person may be admitted to Outpatient Services for one type of rehabilitative service or for a more comprehensive, multidisciplinary rehabilitation therapy program. Outpatient services are offered in numerous settings, such as pain clinics or rehabilitation centers. Other types of outpatient facilities include:
- Medical group practices
- Outpatient clinics at hospitals or other medical facilities
- Dialysis centers
- Surgery centers
- Imaging centers
- Cardiac catheterization centers
- Wound Care centers
- Mental or behavioral health centers, which may provide substance abuse treatment services and mental health services for adults or adolescents
- Adult Day Care centers
- Laboratory centers
- Gastrointestinal centers, which may provide screening or other services such as colonoscopy and endoscopy
- Durable medical equipment rental facilities
Many outpatient service centers specialize in a specific area of medicine, such as orthopedics (bones) or cardiology (heart). These centers, like many hospitals, have advanced equipment and highly trained staff.
Like most healthcare settings where treatment and services are provided by licensed professional staff, outpatient services can be expensive if paid for with private funds. Medicare, Medicaid, and most health insurance providers offer outpatient benefits.
Medicare Part B covers medically necessary services you get as an outpatient from a Medicare-participating facility or center for diagnosis or treatment of an illness or injury. Your Medicare benefit for outpatient physical therapy and speech-language pathology services (combined) is limited to $1740 per year. There is a separate yearly benefit limit of $1740 for outpatient occupational therapy. After you have reached the $1740 cap, you will be responsible for 100% of the charges, unless you have other insurance coverage. There is NO CAP if you go to a hospital outpatient therapy department. Other types of outpatient services like Dialysis Centers, Surgery Centers, and Imaging Centers, Medicare will pay for 80% of approved charges. Medicare will cover 50% of approved charges in mental health and substance abuse centers.
The Department of Veteran’s Affairs Health Administration may be able to provide veterans with general health care, nursing home care, custodial care, home improvement assistance or financial assistance. Eligibility depends upon each person’s individual circumstance and history. Co-payments may apply for certain benefits if one is eligible.
Health insurance may cover costs for outpatient services, however, benefits and coverage can vary tremendously. Please call your insurance company to verify which services and benefits your policy covers and to obtain a list of preferred providers or contact the facility to assist you with this process and determine which insurance policies they accept.
Medicaid may help cover the cost of outpatient services for individuals who meet the requirements and are eligible.
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