Steps to Negotiate the Insurance Maze
OBTAIN
Obtain a copy of the full (not abbreviated or summarized) EXPLANATION OF INSURANCE BENEFITS. Read your policy carefully and thoroughly, including fine print, definitions, exclusions, etc., to learn the extent of covered services.
CONTACT
Find out if you have been assigned a CASE MANAGER and contact that individual; if not, request that you be assigned to a case manager or benefits advisor. To be your loved one’s best advocate, you should educate the case manager about his/her spinal cord injury and particular needs to preserve the integrity of their body and health.
DETERMINE
Determine the REHABILITATION BENEFITS. Inquire about the number of allowed days of coverage for inpatient acute and sub-acute rehabilitation, outpatient and home health rehabilitation; ask whether there is an annual maximum number of days and a lifetime maximum number of days.
INQUIRE
Inquire about rehabilitation in a SPINAL CORD INJURY-ACCREDITED REHABILITATION FACILITY, including both in-state and out-of-state facilities.
VOICE
Contact your insurance representative for ISSUES AND/OR CONCERNS that relate to your health insurance and whenever you have been denied a service that you believe to be covered.
DOCUMENT
Remember to always document/record ALL CONVERSATIONS with your insurance company: Include the date of the call, the reason for the call, the person with whom you spoke and the outcome of the call.
EDUCATE
Educate your INSURANCE REPRESENTATIVE to be an advocate for your loved one’s health care needs. Teach this person the risk factors for the secondary complications of spinal cord injury, necessary measures to preserve the health and integrity of your body and importance of immediate access to insurance and health care professionals.
CONTACT
If your injury occurred while on the job and you have qualified for WORKERS’ COMPENSATION, talk to your Workers Compensation case manager about what options for care are available to you following your trauma care treatment.
Produced by Shepherd Center and KPKinteractive in collaboration with the American Trauma Society, the National Spinal Cord Injury Association and the Christopher & Dana Reeve Foundation.
