What should I do if my HMO refuses to approve inpatient rehabilitation?

Eligibility for rehabilitation is subject to the recommendation of the medical team at the hospital where the patient is hospitalized. At times, this decision is made by a medical team that does not include a rehabilitation doctor, which can lead to mistakes in assessing the chances of continued rehabilitation; and sometimes the HMO overrules the decision of the medical team at the hospital and decides there is no need for inpatient rehabilitation.

If, as a family, you feel that the rehabilitation framework decided upon does not correspond to the rehabilitation potential, you should act as follows:

• Turn to the public inquiries supervisor at your HMO.
• Appeal the decision to the Ministry of Health ombudsman.
• Get help by calling the hotline operated by Neeman and the Society for Patients Rights in Israel.
• If the hospital discharge letter does not include a recommendation for inpatient rehabilitation, turn to a private rehabilitation doctor for a second medical opinion about the need for rehabilitation, in coordination with the department in which the patient is hospitalized.
• Referrals, contact details and more information can be found on the “What is Rehabilitation and What Are Your Rights?” page.
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Who is entitled to choose the department/hospital where the rehabilitation takes place?

The quality of rehabilitation is often conditional on the rehabilitation framework’s geographic location and the convenience with which the patient’s family can make frequent visits.

The law gives you, the insured individual, the right to choose where to be hospitalized from among the institutions with which the HMO has an agreement (“selection of service provider arrangement”). The law obligates the HMO to publish a list of service providers on its website and provide it to anyone who asks.

Referrals, contact details and more information can be found on the “What is Rehabilitation and What Are Your Rights?” page.

Is there an age limit to eligibility for rehabilitation?

There is no age limit. Every insured individual is entitled to the rehabilitation determined by the medical recommendation of the medical team at the hospital, free of charge.

According to section 7.6 of the Ministry of Health director general’s directive “Standards for the Provision of Rehabilitative Care for the Elderly” (read the directive here), in most cases, the priority for elderly people following a non-minor stroke should be institutional rehabilitation.

How long will the rehabilitation last?

Each rehabilitation program is individual and adapted for the patient by the rehabilitation doctor based on the patient’s medical condition. The program is not time-limited, but rather it depends on the patient’s rehabilitative potential and lasts a minimum of two weeks in all cases (if a shorter length of time has been set, this should be justified in the patient’s medical record and discharge letter based on the findings of the comprehensive functional evaluation).

The HMO’s medical committee is permitted to extend the de facto rehabilitation period. The HMO usually provides unlimited rehabilitation as long as the patient’s condition is improving.

If the family believes the HMO is discharging a patient before they have fully exhausted the potential of the rehabilitation process, it can provide a second opinion from a rehabilitation specialist and request an extension of the rehabilitation period.

More details can be found on the “What is Rehabilitation and What Are Your Rights?” page.

Who is responsible for rehabilitation?

The responsibility for locating a rehabilitation institution and funding the costs of treatment at the institution falls on the HMO.

You, as patients, have the right to choose the institution. Find a search engine for rehabilitation institutions on the “Ahead Above and Beyond” (Merosh Ume’ever) website here.

More information about responsibility for rehabilitation and about selecting institutions can be found on the “What is Rehabilitation and What Are Your Rights?” page.

What should I pay attention to regarding the discharge letter from the hospital or rehabilitation center?

The discharge letter will note the patient’s medical condition at both admission and discharge and give precise and detailed recommendations for the type and manner of rehabilitation — in the hospital or in the community.

Medical and functional condition, including psychological condition.

Detailed recommendations about follow-up treatment, including tests that were not performed.

Detailed recommendations about the types of continued rehabilitation required, including duration and frequency.

Referrals to treatments in the community.

A list of the assistive devices required.

At discharge from the hospital: If necessary, it is important that the letter state that the referral is for inpatient rehabilitation and not general rehabilitation, since general rehabilitation can also refer to rehabilitation in the HMO’s physical therapy institute.

Anything that does not appear in the discharge letter cannot be included in a claim at a later stage.

More details about the discharge letter can be found on the “What is Rehabilitation and What Are Your Rights?” page.

Who is the rehabilitation hospital discharge letter for?

The letter should be given to the patient’s doctor and physical therapist and/or any other professional continuing the rehabilitation in the framework of the HMO.

Is everyone who has had a stroke exempt from national insurance contributions?

Those who receive a disability (or loss of earning capacity) pension pay national insurance contributions through the pension. Those who work are not exempt from national insurance contributions.

Is someone who has trouble walking after a stroke eligible for a discounted wheelchair?

A wheelchair can be purchased at a 75% discount from the Ministry of Health, after providing the correct medical documents and authorizations. This can be done through the health bureau in your city of residence. Note that it is also relatively easy to obtain discounts through the HMOs with supplemental insurance.

More information can be found on the “Assistance in Receiving Rehabilitation Equipment” page.

How do I receive equipment and assistive devices from the Ministry of Health?

Approval for receiving equipment and specifications about the equipment is given by the HMO’s continuing treatment unit after referral by the family doctor. The Ministry of Health provides all the necessary equipment on loan (usually with a copayment), including bathing chairs, wheelchairs and beds for acute long-term care patients. It is important to make sure the necessary equipment is listed in the discharge letter. Moreover, it is possible to obtain many items of equipment on loan from Yad Sarah, Ezer Mizion, Ezra Lemarpe and other organizations.

More information and contact details can be found on the “Assistance in Receiving Rehabilitation Equipment” page.

What services does the HMO offer for housebound individuals (home rehabilitation or treatment for chronically ill patients at home)?

The HMO’s “treatment at home unit” provides medical services, nursing, physical therapy, speech therapy, occupational therapy and social work at the homes of housebound individuals.  More information can be found on the “Rehabilitation in the Community” page.

Am I entitled to vocational rehabilitation from the National Insurance Institute?

Vocational rehabilitation is provided to individuals who have been granted at least 20% medical disability, who are not able to work in their previous occupation or any other occupation, and who have been found suitable for vocational rehabilitation.

Vocational rehabilitation services provided include diagnosis, counseling and treatment as well as payment of rehabilitation expenses for those in vocational training.

More information can be found on the “Vocational Rehabilitation” page.

What are the signs of a stroke?

Symptoms that appear suddenly such as:

• Sudden weakness or paralysis of the arm, leg or face on one side of the body
• Tingling and sudden lack of sensation in the limbs (like hand or foot falling asleep)
• Sudden difficulty speaking or understanding speech (confusion)
• Distorted facial muscles
• Sudden loss of balance, instability
• Sudden loss of vision, double vision, blurring or fogginess
• Sudden and unexplained severe headache

If one or more of these symptoms appears, even if they pass quickly, immediately call an ambulance and tell them you suspect a stroke.

More information can be found on the “Early Signs and Getting to Hospital Early” page.

Is it possible to help someone still struggling with language difficulties and lack of confidence caused by a stroke even several years after the event?

Yes. You should find a suitable framework or type of treatment to facilitate and try to improve communication. It is also recommended to explore group options for bolstering self-confidence and learning tools and coping methods with peers who face the same problems. Of course it is also possible to do this work individually.

More information can be found on the “Community Life after a Stroke” or “Consequences of a Stroke” page.

How do I hire a foreign worker?

You must submit a request to the Employment Bureau in Jerusalem and receive approval from the Ministry of Interior to hire a foreign worker. The nursing agencies provide assistance throughout the process.

More information can be found on the “Employment of a Foreign Worker” page.

How do I receive a caregiver and help at home from the National Insurance Institute?

Submit a request for a long-term care benefit directly to the NII. The request should be accompanied by a medical opinion and functional evaluation from a doctor (preferably geriatric) and a declaration of income.

If you are found eligible after tests and examinations, the NII will provide a caregiver through a private nursing agency for several hours per week. You can also get help submitting a request from any nursing agency that provides services to the NII. In this case the agency will even offer a free “pre-long-term care” service until the request is approved.

More information can be found on the “Employment of a Foreign Worker” page.

Who is obligated to pay the health insurance of a foreign worker?

An individual who employs a foreign worker (not through a nursing agency) must pay for private medical insurance for the worker. However, the employer is permitted to deduct a portion of the monthly insurance costs from the foreign worker’s salary.

This obligation applies to all foreign workers, whether legally employed or not.

The worker’s insurance should be renewed once a year.

More information can be found on the “Employment of a Foreign Worker” page.