Outpatient Therapy After TBI: Funded Until COBRA Ran Out

Outpatient Therapy After TBI: Steven Part Seven

Regarding Steven’s outpatient therapy after TBI, it only lasted as long as his Cobra did. Obama Care came with so many compromises, it is unlikely to help in this situation, even when it does come into effect.  Like COBRA, as it is medical coverage based upon the purchase of an insurance policy, there is little hope that it could be used with someone as depleted of assets as someone surviving a traumatic brain injury is likely to be.  The universal coverage, Medicare for all (an idea that couldn’t get through Congress) would have made all of the difference.

We’ve talked about the physical things that you’ve had problems.  At what point were you able to actually start to walk unassisted?

I just recently started walking unassisted without my knee brace in the last six, seven months.  But if I go walking a considerable distance, I still have to go back to it.

Now, you, did you hurt your knee in the accident as well?

No, sir.  It’s just something – and I don’t know what it is.  It’s got metal hinges in it, and it seems like it pulls my leg back up to take the next step better than if I did it on my own.  A lot of times, it doesn’t seem like it’s as stable maybe.

So your understanding of why the knee brace helps you is that it gives your muscles tone and strength that you might not otherwise have?

 Maybe so.

But it’s not actually an injury to your knee?

No, sir.

After you left Baptist sometime in August in the year of your injury, did you get any outpatient therapy after TBI at any point?

I was getting twice a week outpatient therapy through Baptist, and that kept going until my private insurance through the job I had fell through, because I wasn’t able to go back to work.

So you got some continued insurance after your accident through the steel mill?

Actually, the steel mill went ahead and paid my premium for like another couple months to help me out because I guess I was a good worker.

COBRA, Obama Care, Medicaid – where will the money come from for necessary brain injury rehabilitation and outpatient therapy after TBI?  The flaw of course in COBRA is that it requires the disabled person to pay relatively large sums of money, relative to his or her income to continue the coverage.  If other family members are there to chip in, this can be meaningful coverage. In Steven’s case, there was no family to chip in for his outpatient therapy after TBI.

That leaves Medicaid, which is run by the states.  The more conservative the politics in a given state, the less that Medicaid is likely to provide for his outpatient therapy after TBI.

What is an odd irony in Steven’s case is that because he did have insurance coverage at the time he got hurt, there was no one with a vested interest to get him on Medicaid immediately. Normally it is the social workers at the hospital who assist or push through the Medicaid eligibility for someone who is in a coma, which is integrally related to the ultimate finding of eligibility for SSI and SSDI (social security disability insurance).  But as he had insurance, the hospitals didn’t have an incentive to get him on Medicaid to help with outpatient therapy after TBI.  The last thing either of his hospitals wanted was for Steven bills to be paid by Medicaid, because the private reimbursement rate was so much higher.

Thus, the severely brain injured person, was left on his own to figure out how to get eligibility.  Steven, whose eligibility should have been routine because of the severity of his multiple injuries, wasn’t found disabled. Then – the system designed to protect Steven, wouldn’t to his TBI cry for help, because Social Security found his voice was “too clear.”

We can’t get through Congress what is needed –  universal coverage, Medicare for all. Short of that, we should add a provision to the COBRA rules that has the government pay the COBRA premium in the case of brain injury or other catastrophic illness. While making such payments would add some cost to the government going in, what it would save in Medicaid payments would undoubtedly be ten fold.

One can only wish that we lived in a political system where something that was good for the consumer and good for the government, was enough.  Even the health care providers would be happy with this change as they would get private pay reimbursement.  The only losers would be the health insurers who took the bet on Steven’s good health.  It seems only fair and just to make those who underwrote the risk, bear the loss.

A more radical change, but still far easier compromise politically, would be to move up the eligibility date for Medicare in case of a brain injury or other catastrophic injury, to the date of injury, not 29 months later.  Congress is spending billions on research right now for curing TBI with our soldiers. This combined with the publicity of the NFL’s new concussion policy, maybe the time is right for the brain injury community to push through something like this.

Next in Part Eight – Getting Turned Down for Social Security for Being Too Smart

By Attorney Gordon Johnson

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