A Stacked Deck (insurance II)

There is no way to plan for it – brain injury comes out of nowhere.  Without a moment’s notice brain injury changes everything.   The physical, emotional, and psychological damage is irreparable.  But what of the monetary strain?  The US doesn’t provide universal health care coverage.  What can families do at times like this?

 

The health insurance companies convince us to take out comprehensive coverage for exactly this reason.  Saying that in case we get sick or something goes wrong then we won’t have to worry about anything but getting better.  They assure us tell us they are good neighbors, who keep promises, and enrich our lives, we will be in good hands if we with them.... And like sheep to the slaughter we sign and pay. What choice do we have?

 

In the USA insurance is extremely useful, almost necessary. For uninsured Americans, the cost standard doctors visits, prescriptions, or vaccinations is practically unaffordable Citizens pay high premiums to help with doctors’ bills, medications, and to ensure we have the health care we need if there is an emergency.

 

To be fair, companies do hold up their end of the bargain on every day issues, Johnnie’s asthma inhaler or Jane’s checkups.  Unfortunately companies are not the great protectors they claim, and paying a monthly fee does not insure the promised protection. 

 

Insurance is a numbers game with the cards stacked against the client.  Companies refuse to cover preexisting conditions, won’t insure individuals deemed risky, will raise premiums if there is a large claim, and deny any coverage they can.   When the chips are down insurance companies do everything the can to get out of their obligations. When a client does suffer a costly injury, the insurance company will do everything in its power to deny benefits, and brain injuries plays right into their hands. 

 

Because brain injury is “invisible,” and not as clear-cut as a broken leg, insurance companies have notoriously poor coverage for head injuries.  Companies will often refuse to pay for cognitive therapy entirely claiming that it isn’t medically necessary.  If a survivor looks fine then they must be fine.

 

 

At the client’s most vulnerable moment when the patient does not have the cognitive capacity to argue and her advocates frequently don’t have the energy.  Instead of protecting and providing the promised insurance they do everything in their power to get out of covering costs stall, fight, or simply deny cognitive rehabilitation benefits. With all of the paperwork, hoops to jump through, and rejections, fighting with the insurance company can be almost as draining as the injury or the illness itself.

 

Moreover, the stress and pressure of lawsuits, arguments, and these problems is extremely harmful to the survivor’s recovery.   Some of my worst brain injury-related “attacks” ranging from moments of terrible vertigo, nausea, excruciating headaches, meltdowns, and more have been brought on due to stress from battles with the insurance company.  So you’re damned if you do and you’re damned if you don’t.

 

After my accident, though my family was covered by what was supposedly an excellent policy, the insurance company flatly refused to cover my cognitive therapy.  Fortunately my parents were aware of how important it is for survivors to start therapy as soon after the accident as possible.  Rather than wasting time with a long, drawn-out bureaucratic battle, my parents took matters into their own hands. Without hesitation they made the necessary sacrifices and paid out-of-pocket for as much rehabilitation as they were able.  Unfortunately many families do not have the resources for this, realize how vital the days directly following the injury are to a good recovery, or have a strong support system.  And that is just through the acute rehabilitation (immediately after the injury).  Things don’t get better over the long-term.

 

It is always best to take care of problems as soon as they arise – a stitch in time saves nine.  In this instance it is no different.  Because of inadequate care many survivors are not able to progress as far as they could.  This inevitably raises the cost of long-term care both for the family, insurance, and society.  This cannot continue; something must be done … but what?

 

There is no easy solution to the problem. Ideally the USA would have a universal health-care system – a safety net of accessible health care available to all citizens.  Though the current administration is making steps in that direction I cannot see it happening in the near future. 

 

Happily we are making small steps forward; in 2001 the US government passed legislation mandating that insurance companies cover some rehabilitation for ABI (acquired brain injury) survivors.  However the insurance companies try every loophole they can to get out of covering these costs, excluding rehabilitation as a mental health problem for example.  In other words insurance companies’ care of ABI survivors is still sorely lacking. 

 

Though all ABI issues are close to my heart this one hits particularly close to home.  I am intimately acquainted with how nightmarishly ugly battles with insurance companies can get.  Because of this, I realize that I am not able to look at this issue objectively, but I also am more driven to help fellow survivors in similar situations.  I am currently looking for others passionate about raising awareness and helping survivors who cannot afford needed therapy.  My goal is to found an NGO and raise money to help survivors get the therapy they need, find appropriate alternative therapies, and raise awareness of this issue.  I ask that you please contact me if you are interested in working on a project like this….

 

 

ASHA Poll: Inadequate Insurance Coverage Hinders Public’s Recovery From Traumatic Brain Injury http://www.asha.org/about/news/tbievent/tbipressrelease.htm

 

Study of Health Benefit Plan Coverage for Brain Injuries Summary http://www.sunset.state.tx.us/80threports/hcbi/summary.pdf

 

Health Insurers Deny Coverage for Cognitive Rehabilitation http://www.neurotodayonline.com/pt/re/neurotoday/fulltext.00132985-200703060-00014.htm;jsessionid=K6wdlFQ3vjSywctQpkdGDPyLpFQCShbw2rwLqHb1HD1KRV9pplQw!-514211921!181195628!8091!-1