The unthinkable has happened – you or someone you love has experienced a brain injury. Now, you need to work with insurance companies to receive care. There are different types of brain injury rehabilitation services and insurance coverage for each will vary depending on the service and your individual insurance plan. Navigating brain injury and care is difficult enough, but adding the insurance process to the mix makes the situation even more challenging. This is why BIAA has compiled a guide to break down the types of brain injury care and how insurance factors into the rehabilitation process. The guide will help patients and their advocates understand the array of products, the specialized language that insurance policies contain, and the claims process. The guide outlines the steps you can take to maximize insurance coverage for medically necessary treatment and services after injury. The guide does not discuss Medicare or Medicaid, but it includes resource listings for these and other public sector programs.
The insurance guide contains information about:
- Care needs
- There are two categories of care options: acute and post-acute. Acute care involves the treatment a brain injury survivor receives in the immediate aftermath of the injury. Post-acute care constitutes the treatment a person receives outside of emergency care in the hospital and is more long-term.
- Types of insurance
- Many individuals who sustain a brain injury need to receive treatment to manage the effects of their injury. Insurance helps to pay for these treatments. Unfortunately, having insurance doesn’t always mean that needed services will be covered. Understanding the type of insurance and the plan benefits — what’s included and what’s excluded — will make advocating for coverage easier.
- The fine print
- Most insurance policies contain legal language and industry jargon that may be difficult for consumers to read and understand. Taking the time to become familiar with key terms now will make your advocacy efforts easier and more successful later on.
- The appeals process
- Review the policy language to understand the level of appeals available to you in response to any denial of services. The type and number of appeals will vary based according to plan. Your plan may identify requirements for pre-service determination, concurrent requests, retrospective review, peer review, initial appeal, secondary appeal, and expedited appeal.
Download the guide below.
