(Cont’d)
Expenses of Recovery and Rehabilitation
After release from the hospital, coverage for follow-up care and rehabilitation may not be all-inclusive. Other terms, benefits and limitations of your policy you should investigate include:
- Medical equipment
- Physical therapy and mental health
- Home care or custodial care
An area of red tape that may entangle some families is obtaining behavioral rehabilitation services and treatment for a variety of psychological disorders that frequently develop following a traumatic brain injury. Some policies may exclude coverage for psychiatric services. It may require a persuasive argument or the services of an attorney to obtain benefits for mental healthcare services directly related to a physical injury.
Benefits of a Case Manager
If your policy provides for a case manager, this service may help you cut through the red tape. Sometimes the case manager can negotiate payment of expenses that are not technically covered by the policy by trading the costs for a benefit you have but that won’t be needed. For example if care in a nursing home is covered, but at-home assistance is not, it’s obviously in the insurance company’s interest to cover the at-home care so you don’t have to use the nursing home benefit. A case manager can help make such things happen.
When You Need Help
If you need help understanding your policy’s benefits, limitations and exclusions, consult your insurance agent, or if you don’t have an agent, call your insurer. Many policies provide access to someone who can not only explain your policy, but also assist you during the entire time that ongoing care or treatment is needed.
If you think you’ve been treated unfairly, don’t rush off to find a lawyer. Your policy very likely spells out an appeal or grievance process for addressing your concerns, and may include terms for binding arbitration in the event of an unresolved dispute. If you’re not satisfied with the outcome of the appeal or grievance proceedings, then you may want to take advantage of a free consultation with an attorney specializing in insurance law.
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This article is featured in “The Second Carnival of Special Needs and Money” at Kim Greenblatt’s blog “Profitable.”
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Thanks for participating in the second carnival of special needs and money.
Kim Greenblatt