Maximum Benefit Limits for Ongoing Treatment
A patient receiving physiotherapy for post-surgical rehabilitation faced claim rejections after reaching the maximum allowable benefits for Medicare-covered sessions.
Challenges
- Providers were unaware of Medicare benefit exhaustion.
- Patients expected continued coverage, leading to financial disputes.
- No structured alternatives were initially provided.
Resolution
- Integrated automated benefit tracking to flag approaching limits.
- Established payment plans to help patients continue treatment.
- Explored alternative funding (private insurance/self-funded discounts).
Outcome & Lessons Learned
- Proactive financial counseling improved trust and patient engagement.
- Clinics improved coordination with Medicare to anticipate benefit exhaustion.
- Clear financial planning reduced billing disputes and confusion.