An Unpleasant Truth About Insurance Coverage For Patients With Traumatic Brain Injuries

This post was authored by Jon Stefanuca and posted to The Eye Opener on March 10th, 2011.

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traumatic brain injury

Since Arizona Rep. Gabrielle Gifford was shot in the head about three months ago, the internet was flooded with articles about her recovery and the nature of her injuries. During this time, some news sources began to explore the nationwide availability of rehabilitation resources and insurance coverage for patients with traumatic brain injury (TBI). The truth about the availability of insurance coverage for TBI rehabilitation is truly frightening.

According to an article published by ABC News, insurance coverage and rehab services are quite scarce when it comes to patients who require long-term TBI rehabilitation. It appears that private as well a publically funded insurance plans, including Medicare and Tricare, exclude many types of cognitive rehabilitation services, particularly when the patient requires long-term placement in a nursing home or rehabilitation facility. As a result, thousands of patients, including U.S. military members and veterans are left without necessary TBI rehabilitation.

The Tricare Coverage Manual, for example,  states that “[c]ognitive rehabilitation services designed to improve cognitive functioning after a brain injury are not supported by reliable scientific evidence of efficacy.” Apparently, this attitude towards cognitive rehab is not uncommon in the insurance industry. Even America’s Health Insurance Plans (AHIP) claims that cognitive rehabilitation has no benefit to patients with TBI, according to Susan Pisano, a spokesperson for AHIP.

To better understand traumatic brain injury and how rehabilitation can give a TBI victim a meaningful life, watch this video by the Research Channel.

httpv://www.youtube.com/watch?v=FgtHvBF4t-E&feature=related

This resistance from the insurance industry persists despite the fact that cognitive rehabilitation has been shown to be quite helpful. According to the Brain Injury Association of America, a number of studies have shown cognitive rehab to be very effective for patients with TBIs.  If you or a loved one were denied coverage for TBI rehabilitation, we encourage you to share your story with our readers. How did you handle the situation?  If you were ultimately successful in securing insurance coverage, how did you do it? If you found other sources of funding for TBI rehabilitation, please share your story and information so others might benefit from your experience.

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