Questions to ask an insurer or funder before rehabilitation starts

Confirming the approval itself

• Is this specific service approved, and under which claim or plan number?
• What is the approval reference, and can I have it in writing?
• What date range does the approval cover?
• How many sessions are covered before a review is required?
• What form or report is required to request more?

Money

• Which fee order or price limit applies to this service?
• Will the full fee be paid, or is a gap expected?
• Are travel, report writing, case conferences and non-attendance payable?
• How and where should invoices be submitted, and what is the payment time frame?

Provider requirements

• Does the provider need scheme approval, accreditation or panel status for this service?
• Is there a preferred or contracted provider arrangement that affects choice?
• Can the person change provider, and what notice is required?

Reporting and reviews

Most funders expect progress reporting against goals, and will make continued funding conditional on it. Agree the format and frequency at the start rather than discovering it at the review.

• What outcome measures or goal framework do you expect?
• When is the first review, and who attends?
• What happens to sessions already booked if a review is delayed?

If something changes

• What happens if capacity changes or a new problem emerges?
• Who do I contact if the approval expires mid-program?
• How are disputes about a declined service handled, and what are the time frames?

Recording the answers

Write down the date, the person you spoke to, the reference number and the exact wording of what was approved. Where a scheme provides written approval correspondence, keep it with the referral file. This protects the person receiving care as much as the provider.

Get Rehab does not determine claim eligibility, funding approval, legal rights or medical suitability. These questions are intended to help you get clear answers from the party that does.