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Sen. Mark Kirk's care went well beyond most insurance plans

Published: Friday, Jan. 4, 2013 9:30 a.m. CST

(MCT) — Medical professionals who treated U.S. Sen. Mark Kirk said Thursday that the Illinois legislator received 300 to 400 therapy sessions during his ongoing recovery from his January 2012 stroke.   

The intensive treatment, administered over 10 or 11 months in inpatient and outpatient settings, included 100 to 200 sessions of physical therapy, 100 sessions of occupational therapy and 100 sessions of speech therapy, officials from the Rehabilitation Institute of Chicago said at a news conference in Washington.

When asked how Kirk paid for the extensive therapies, his spokesman Lance Trover said Thursday that Kirk has the same health care insurance options available to other federal employees and has incurred major out-of-pocket expenses, which have affected his savings and retirement.

According to the medical professionals, 40 of Kirk's 300 to 400 sessions were not billable because they were part of a medical trial in which the senator took part. But the rest of the sessions appeared to be well beyond the number that would be covered for most Americans under commercial and government-subsidized health insurance plans.

"Generally, most plans have a cap of around 20 (sessions) for each of those three categories, which are subject to review by a medical management team," said Dale Moyer, president of Chicago-based Incentovate LLC, which advises employers on compensation and benefit plans.

Patients who seek therapy beyond what's covered by insurance will generally have to pay out-of-pocket, often at a rate higher than what their insurance company pays.

Both Medicare, the federal-run health insurance program for those 65 and older, and state-run Medicaid have caps on the amount of outpatient physical, occupational and speech therapy that patients can receive each year. 

Under the Illinois Medicaid program, patients are limited to 20 sessions per year in those three therapy categories, with no exceptions, said Mike Claffey, a spokesman. The state had no limit on such treatments until last July 1, when changes passed by lawmakers kicked in that aimed to save money in the financially strapped program. 

Medicare, meanwhile, provides patients with benefits worth up to $1,900 in 2013 for both occupational therapy and a combination of physical and speech therapy.

Patients who exceed that limit can qualify for exceptions if the treatments are deemed medically necessary. In cases in which the government approves exceptions, Medicare will continue to pay its share.

Many private insurers, however, are firm with the coverage caps, experts said. That's because therapy visits are one of the ingredients in the underwriting process that determine how insurers price plans.

Some large employers that self-fund their health insurance plans tend to grant more exceptions to employees.

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