What to Expect from Your Insurance Company AFTER a Traumatic Brain Injury – A Primer

As Rhode Island’s leading injury law firm, we regularly speak with clients who suffer from a concussion, head trauma, or traumatic brain injury (TBI). Oftentimes our clients are unsure what brain injury tests and treatments are covered by their health insurance.

Most clients have basic health insurance plans, and the coverage is contingent on their selected plan, pre-existing conditions, deductibles, and other factors. There are some items, however, which can be expected to be covered by insurance. 

• Emergency Room Care: Under the Affordable Care Act, health insurance plans are required to cover emergency services. Following an accident, a trip to the E.R. will be covered under insurance, including all testing and treatment performed while in the care of emergency services. 
• Surgery: If a surgical procedure is required, insurance will typically cover a major portion of the cost of surgery.
• Long-term treatment and therapy: Oftentimes, TBIs cause life-altering injuries that may need extended treatment, including physical, speech, occupational, mental health, or other types of therapy plans. However, these therapies have more stringent restrictions on the frequency and provider who can perform the treatment. 

When developing a long-term brain injury treatment plan, it is important to get guidance on this plan from your medical providers. There are no standard treatments for head injuries, and every plan is customized. Treatments may include significant rest, psychological counseling, physical therapy, cognitive behavior therapy, speech therapy, vocational therapy, or occupational therapy. From our experience working with hundreds of clients who have suffered a TBI, we understand the importance of these treatments as well as the need for ongoing care.

It’s important to discuss the details of the individual treatment plan with your insurance company to determine what will be covered and what expenses may be your responsibility. 

The Marasco & Nesselbush team continues to work to make sure our clients are receiving the medical treatment necessary to heal their injuries while we advance their legal claims.