Insurance companies deny rehabilitation costs for treating TBIs

In our last post, we talked about the problems individuals face after they suffer traumatic brain injuries (TBIs). Although intensive rehabilitation therapy is the most effective way for individuals to regain full use of their limbs, language skills, emotional balance and thinking abilities, many people do not have the money to put their loved ones in such expensive care. Although insurance companies may help with the initial surgery and hospital stay, in New York, there is no law or standards that require coverage for long-term services.

According to the Centers for Disease Control and Prevention reports, more than 1.7 million people in the United States suffer traumatic brain injuries each year. Of that group, about 50,000 die; 230,000 are hospitalized; and about 90,000 live with long-term disabilities.

Those who live with disabilities often put huge amounts of money toward medical care and lost productivity. Why? Because many people don’t know that additional rehabilitation services are available.

It’s no secret that insurance companies are not your friend. Insurance companies are a business, and they can’t make money if they are always giving it away. As a result, many insurance companies are not open about the rehabilitation services that are available. In the past six months, the insurance company that works for the Department of Defense refused to pay for intensive therapy for soldiers. They said the therapy was experimental and lacked sound research proving the results were consistent.

However, the individuals who work in the field know the rehab is effective. They believe the shortcoming of the therapy is the lack of published research showing its effectiveness. When individuals with traumatic injuries do not successfully complete rehabilitation, they often shrink into the background, resting in nursing homes or rarely able to leave their homes. Without public awareness, many people suffer alone, believing – as their insurance companies tell them – that there are no effective treatment options available.

Read the next post in this mini-series to learn more about the complexities of brain injuries and elements of hope in research and insurance coverage.

Source: USA Today, “For brain injuries, a treatment gap,” Steve Sternberg, 2 March 2011