October 1, 2023

Any sudden blow or bang on the head that causes severe injury to the brain affects the brain tissues. This damage can result from car crashes, falls, brain surgery, infection, etc. Such conditions may lead to traumatic brain injury (TBI)

The severity of TBI depends on the damage caused to the brain tissues. Severe damage can lead to loss of certain body functions and may also cause comatose or death. TBI is one of the leading reasons for causing disability or death in children and young adults. In the United States of America, 29% of children’s hospitalizations are because of TBI, as they are more prone to falling and injuring themselves. 

Long-term impairments caused by TBI

TBI can affect different people with different intensities depending on the damage caused to the brain. In case of minor injury, the effect of the damage may last for a few hours to a few days. However, in severe cases, the damage caused to the brain tissue may be long-lasting and thus affect the victim for a lifetime

The effects of the TBI on a patient dependon the part of the brain tissue affected. Depending on the areas of the brain, certain activities may be affected. For example, the TBI can alter cognitive skills, speech, hearing capability, limb movements, etc. This effect of TBI on the cognitive or physical skills of the patients has a significant impact on the patient’s behavioral and social abilities. 

Circumstances that cause traumatic brain injuries

There are many types of events that can lead to brain injury. These include road or automobile accidents, falls or blows to the head while playing games, sports, or recreational activities, hitting any hard object on the head, falling s at home or workplace, hit on the head during an assault, etc. In short, any event that has a harsh impact on the head and affects the skull and brain can lead to traumatic brain injury. 

Know your private health insurance coverage to avoid any gaps in coverage

Different parameters are considered while providing health coverage to TBI patients. This includes factors like age of the patient, age, mechanism of injury, the severity of the injury, post-resuscitation Glasgow Coma Scale (GCS) score, post-resuscitation blood pressure, post-resuscitation pupillary reactivity, duration of post-traumatic amnesia, intracranial pressures, body balance ability, and effect on cognitive skills, etc. 

How does TBI affect the individual’s ability to maintain private health insurance coverage after an injury?

The health insurance provided to the people in the USA is mostly through their jobs. If the person having the traumatic brain injury has severe brain damage, it might affect their everyday activities and thus, cannot continue their work. 

40% of cases of TBI lose their ability to perform their job, leading to disruption of the working ability. This makes the TBI victim unemployed and is left uninsured. In such cases, the patients may lose the insurance coverage, as they cannot continue doing their job. 

Understand what type of treatment your policy covers

The different steps that need to be considered while maximizing the coverage for the traumatic brain injury include:

  • Checking for the state health care mandates in your state that apply for traumatic brain injury. Documentation of the loved ones’ progress and condition throughout their recovery process with the supporting pictures, videos, and supporting documents. 
  • Saving the claim file along with the documents and records for deciding whether to approve or deny any treatment. 
  • If in case of a refused claim or if the amount of insurance is reduced, the patient or a person on behalf of the patient can complain to the insurance company, or state insurance commissioner

Policies provisions to help pay for rehabilitation services following a TBI

The rehabilitation for TBI patients is essential as it helps them improve their functional ability post brain injury. The rehabilitation program for each patient varies depending on the severity of the injury and their current condition. Most insurance companies cover the rehabilitation needs based on the type of insurance. The different rehab conditions include: 

  • Inpatient rehabilitation,
  • Outpatient rehabilitation,
  • Home-based rehabilitation,
  • Comprehensive day program,
  • Independent living center, etc.

The treatments included in the rehabilitation program depending on patient condition include:

  • Physical therapy,
  • Occupational therapy,
  • Physical medicine,
  • Psychiatric care,
  • Psychological care,
  • Social support,
  • Speech and language therapy, etc.

It is crucial to understand the insurance implications of traumatic brain injury as insurance companies cover the treatment and rehabilitation of TBI patients, helping them recover from the trauma.