“I anticipate Matt’s stay will be approximately 30 days at Sunnyview,” announced the social worker.

My heart skipped a beat, and involuntarily, I responded in wide-eyed disbelief and filtered hysteria, “That’s not enough!”  My face drained of color, and my hopes shattered as I imagined the worst. I stuttered, “Matt needs months of therapy.” How would Mike and I manage if they released him after only a month?

This was our initial meet-and-greet to get me up to speed and review the staff’s initial assessments and thoughts on Matt’s situation. “What about his health insurance?”

The underlying premise behind this candid projection finally came to light, “The coverage of some insurance plans is limited. You should be prepared for that scenario, in case.” How unfortunate for those to whom this applied, but it did not apply to Matt. I took a deep breath and relaxed a bit, ready to take the defense. I was well-versed regarding the salient points of Highmark Blue Cross Blue Shield’s provisions. I was able to clearly articulate that it provided 100 days of inpatient rehabilitation followed by an additional 100 days at a sub-acute facility if necessary. Was I missing something?

I learned that the social worker was still screening his plan and learning its nuances since every plan differed. She was obliged to call Highmark with weekly status updates, followed by a 24-hour delay to receive a verdict. As long as Matt required two medical services, such as PT, OT, Speech, or Nursing, and his ongoing improvements met their criteria, his stay would be extended another week. Week by week.

Once the initial shock wore off, this process didn’t overly concern us. As therapists, Mike and I had written hundreds of reports on behalf of our patients, and we knew what constituted a justifiable continuance at Sunnyview. Based on initial interactions, the various therapists and nurses affirmed that Matt was a good candidate for ongoing therapy—he checked all the boxes; we need not worry.