Paying for Medical Costs of A Brain Injury

by Steve Holder on June 25, 2008

As if the physical and emotional hardships of a traumatic brain injury aren’t enough, the financial strain of paying for medical bills, rehabilitation and on-going care adds tremendously to the stress for victims and their families. Estimates of the lifetime costs to an individual for a traumatic brain injury range from $85,000 for a mild injury to as much as $3 million for a severe TBI.

Health insurance is usually the primary avenue for taking care of medical expenses. But even with substantial medical insurance coverage, you can encounter obstacles and limitations in obtaining benefits for rehabilitation and long-term care when needed. And when health insurance is inadequate or non-existent, you’ll have to explore other resources for meeting the expenses of hospitalization and a lengthy recovery.

This guide will help you identify the resources potentially available to you.

The Costs of Acute Care

In the United States, critical care is provided without regard for financial means. Technically, you will still owe for the costs afterward, but essential care cannot be denied or withheld based on inability to pay.

For those who have no insurance and no resources to pay these expenses, medical providers are sometimes reimbursed a portion of their costs through state or county government programs for indigent care. In other cases, the medical providers may simply write-off the costs. But until the debt is actually forgiven, dismissed or settled, providers may continue to seek payment.

Medical Insurance

A typical health, medical, or hospitalization policy will take care of the majority of medical expenses during the hospitalization phase of recovery. Each policy has its own terms, exclusions and limitations. You should be aware of the following regarding your insurance:

  • Deductible - amount you must pay before insurance starts paying
  • Co-pay or co-insurance – percentage of each bill you’re responsible for paying after the deductible is met
  • Maximum out of pocket – total of your deductible and co-payments you must reach before insurance starts paying 100% of expenses
  • Maximum annual benefit – when this limit is reached, insurance coverage ends until the next year
  • Maximum lifetime benefit – after total insurance payments reach this limit, the policy is canceled

Fortunately, the majority of head injury cases involve only mild brain injury and the hospitalization expenses are not likely to exceed annual or lifetime benefit limits. A severe injury, however, could trigger either one of those caps and leave you without additional coverage. That’s when you’ll need to find other sources for paying medical bills.

(See Traumatic Brain Injury – The Medical Insurance Maze for more detailed information and discussion of coverage for recovery and rehabilitation expenses.)

Automobile Insurance

Some automobile insurance policies include medical benefits for injuries received in an auto accident whether or not the vehicle belongs to the injured party. Coverage can extend to pedestrians injured by the vehicle as well. If the accident involves someone else’s vehicle, be sure to check their policy and yours. You could be eligible for benefits under both.

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