While the emotional and physical issues that are faced following a brain injury can be extremely difficult, insurance issues can be very challenging as well. The type of insurance the patient has can have a significant impact on the level of care the patient receives, particularly after the patient has been stabilized.
Health Insurance Coverage
Coverages and benefits vary depending upon the insurance policy or plan. While most people will thankfully never have the need to read the fine print in their policies, those who experience a brain injury will most likely be affected by the following:
- Lifetime coverage limits – Some companies institute a lifetime limit on their policies, which can be reached by those with a brain injury relatively quickly.
- Subrogation clauses – This is a provision that gives somebody the right to act on behalf of another person in legal actions related to the subject of the contract.
- Therapy benefits – Stipulates the amount of therapy visits allowed per year.
- Home care benefits – Stipulates the amount of home care benefits allowed per year.
- Durable medical equipment – Tells the insured what kind of medical equipment is covered, and in what situations.
Medicaid is a type of health insurance available to those who can’t afford to pay for some or all of their medical bills. Federal and state laws determine who is eligible for Medicaid. Medicaid is paid directly to the patient’s healthcare providers, and in some cases the patient is required to make a small co-pay. Medicaid can also be used as secondary insurance.
Some states offer “Medicaid waivers” These are different programs and services offered at different populations. Since the waivers differ from state to state, it’s a good idea to check into your state’s specific programs. In many cases, there are waiver programs that are appropriate for those with brain injuries. Waiver programs might include services such as physical, occupational, and speech therapies; daily living services; aides, nursing services, and respite care; environmental accessibility adaptations; home-delivered meals; transportation; and adaptive and assistive devices. The state agency that is in charge of Medicaid waivers can be contacted for more specific information regarding both services and eligibility.