Guiding Principles When Selecting a Brain Injury Rehabilitation Program
Be Curious and Ask Questions
While you know your loved one best, you are likely not familiar with the wide range of programs, services, resources, and information in the brain injury rehabilitation field. Learn as much as you can about any program that might be appropriate for your loved one by asking questions about its staff, service philosophy, history, and method of collecting outcome data. If you do not understand something, ask someone at the program to explain it in the detail you need. Like medicine, brain injury services are often as much an “art” as a “science” and can vary widely from program to program.
Learn From Others
When researching multiple programs and services, try to talk with individuals who have participated in each one. Support groups are often a good way to find people who have had experience with a program you are considering. Ask the facility or organization to provide references of individuals who have used their services. Sometimes, due to privacy concerns for those receiving services, you may not always be able to get references.
In many states, consumers can access information about the quality and performance of programs and facilities that are licensed or accredited. Ask prospective facilities how to obtain outcome data and quality information about their program.
You can also check out the program or service provider online, keeping in mind that those who have had negative experiences are most likely to complain, and their experiences may not be fully representative of the quality of a given provider.
Explore More Than One Program
Whenever possible, thoroughly consider several options. The closest program or the one that offers the most services may not necessarily be the best for your loved one’s individual needs. Be wary of anyone who tries to pressure you, while paying attention to any time constraints that may result from limited availability or time-limited access to benefits. Remember that the quality of services cannot be judged solely by how nice the facilities or marketing materials appear.
Get it in Writing
Keep a log of who you spoke to, the date, and a summary of your conversation. Keep copies of all correspondence. There will be a lot of information, including new and technical terms to process, so it is easy to forget details. You may wish to record your conversations so you can refer to them later. Be sure to ask permission in advance; most professionals will readily agree to be recorded. Get any commitments in writing of the types, quantities, and costs of services to be provided before you finalize your decision.
Know Your Financial Situation
Find out about public or private benefits your loved one may be eligible for and apply promptly. Depending on what kind of services are needed, talk with your insurance carrier, managed care organization, or other health care payer to find out how much it will pay, for what services, for how long, and under what conditions. Ask about deductibles and co-payments. Get a copy of your insurance policy or health plan and re-read it. Find out the extent of your financial obligations. Ask about the long-term implications of decisions you make today.
Before services begin, be prepared to fight denials by your insurance company. “No” does not always mean “no.” BIAA has published a free guide called “Navigating the Insurance Maze” that can be downloaded at https://www.biausa.org/insurance. Be prepared for ongoing negotiations with insurance representatives and contact the BIAA affiliate in your state to be referred to advocates who can help.
Get a written disclosure statement from the provider before services begin. The statement should document what services will be rendered and exactly who will be responsible for payment, co-pays, and deductibles. Get regular updates about where you stand financially with the payer and the service provider(s).
Be Involved, Stay Involved
The ultimate goal is to help your loved one succeed. Brain injury programs and services should promote self-determination and community integration to the fullest extent possible. Self-determination can be achieved by deciding how you wish to use your and your loved one’s time, energy and resources. Voice your opinions, questions, and concerns promptly and respectfully.
Choosing brain injury programs and services may be the single most important decision you make emotionally, financially, and for your loved one’s outcome. Take the time to make good decisions. Once services begin, stay on top of what is being provided and what other options exist. Be an informed consumer.
This article originally appeared in the Brain Injury Association of America Maine Chapter Brain Injury & Stroke Resource Directory, Second Edition ©2018.