I know there are new regulations every year. My wife is a coding specialist.
But, the elephant in the room is this: our government-paid health care is based on a prosperity model where we can afford to pay for whatever people want (OT for a retired person???). When the economy could support it, this was acceptable; but now we can’t afford it. We simply do not have the money.
As I said, its too hard to make cuts because someone’s ox will always be gored, so lets just keep going until the whole system crashes then we can do 100% cuts across the board.
That’s a correct assumption if the OT was working at an Workman’s Comp/Occupational Health clinic or as an workplace ergonomics specialist.
If the retired person were to have a stroke or a major orthopaedic event, they’d want an OT to help them with relearn
or learn compensatory strategies for their ADLs (activities of daily living) such as dressing, showering, eating, toileting etc. It’s tough for anyone to learn to live with only one side of their body working properly, it’s even harder for the geriatric population.
It’s a mathematical impossibility for a society to provide free health care when the average individual’s aggregate lifetime healthcare costs outstrip the average individual’s aggregate lifetime earnings. It really is that simple.
Re: OT for a retired person?
OT deals w/adaptive skills for daily living. Retired or not, folks need to get around, reach for and retrieve things, wash, dress and feed themselves, use a bathroom. In my area, OT also may deal with helping patients after joint replacements and vascular surgery after their PT sessions are ended. No patient has the ability to demand PT/OT, although they can ask. It is solely at the discretion of the MD, who, in turn, is subject to the protocols of the institution.
My husband is a medical massage therapist in private practice. He sees these people, often on referral, after their PT/OT ends. There is a cap on number of sessions allowed per patient/per incident. PTs and OTs are subject to restrictions by the referring MD, such as limited area to be treated and limited time per session. These restrictions have been in place for a long time. The PTs themselves are fine with someone seeking private sessions.
The major hospital for our area charges $350/massage done on premises and the patient is responsible for the $60 copay. This makes a $50 private massage session affordable. However, the hospital-based MTs are not paid $350 or even $50.
Many PTs here are in private practice and can accept insurance. Massage is not covered, so I don’t know what the insurance pays. However, MTs must code the session if there is a cafeteria allotment and reimbursement on the employer-provided insurance. Only one or two codes are acceptable for reimbursement and they do change yearly. These sorts of insurance allotments are usually limited to a set amount per year.