The controversy surrounding the medical treatment of our recovering soldiers and veterans has put traumatic brain injury on the radar for millions of Americans. With hundreds of bombings occurring monthly in Iraq, an estimated 10% of the 1.5 million troops who have been deployed there have suffered a brain injury during combat.
But a traumatic brain injury can happen without being in a war zone, and it can happen to any one of us. Motor vehicle crashes, fallsany accident in which the head is struckcan result in such an injury, which can require months of rehabilitation.
The good news: Advances in scientific and clinical cognitive-therapy research give patients a chance to recover and resume an independent life. Many recent studies have proven that people with traumatic brain injury can make significant progress with appropriate treatment.
The bad news: There is very little chance the therapy you need will be covered by your health insurance. Incredibly, the same insurance companies that willingly pay for a Viagra prescription are refusing coverage for cognitive rehabilitation after a brain injury.
There are an estimated 5.3 million Americans living with a cognitive-linguistic impairment related to traumatic brain injury, and an additional 1.5 million to 2 million people sustain such an injury each year. To put these figures in perspective, there are about 176,000 new cases of breast cancer a year, and about 51,000 new AIDS cases are reported annually in the U.S.
The incredible progress made by ABC News anchor Bob Woodruff, who suffered a severe head injury one year ago from a roadside bomb in Iraq, demonstrates the power of appropriate rehabilitation therapy. Woodruff believes the quick action of the doctors on the field as well as his intensive rehabilitation program deserve credit for his recovery. Rehabilitation is so critical, he has said.
The public has a huge stake in brain injury rehabilitation. In 2000, the estimated annual cost of medical care and lost productivity because of brain injury topped $60 billion.
More than 700 published studies have proven the efficacy and cited the benefits of cognitive rehabilitation after brain injury, dozens of which have followed the most rigorous research design. Cognitive rehabilitation has also been endorsed by a National Institutes of Health consensus panel. Exciting new research suggests that, with the right therapy, damaged brains can adapt by creating new pathways between cells, and newly formed neurons are able to compensate for injured cells. Contrary to conventional belief, this healing can take place even years after an injury occurs.
Despite all the evidence citing the benefits of cognitive rehabilitation, most insurance companies deny coverage or limit the scope and duration of traumatic brain injury patients treatment. While cognitive rehabilitation cannot absolutely guarantee full restoration of all cognitive abilities, denying coverage effectively blocks all of us from a promising path to healing.
The traumatic brain injury patients medical team includes speech-language pathologists, who help patients regain memory, speech production, language formulation and the ability to plan and execute daily tasks. Encouragingly, the latest data from the American Speech-Language-Hearing Association reveals that traumatic brain injury patients who received the appropriate level of speech-language pathology services made significant gains in key areas such as attention (82%), memory (81%), and problem solving (80%).
However, because of coverage limitations, these professionals cannot fully conduct the kind of work that brings about such positive results. Instead, they are forced to provide stopgap treatment, hoping to reach limited goals within arbitrary allowable timeframes. Often, they cannot supply restorative treatments or even teach patients how to deal with future needs.
Fortunately, some insurance companies and state legislatures have seen the light. For example, Blue Cross and Blue Shield of Iowa and Aetna have revised their policies to include some cognitive rehabilitation coverage. Medicaid waivers for cognitive rehabilitation are now available in 14 states, and 12 states are legislating for public programs related to cognitive rehabilitation.
There is some recourse for those who are denied needed services. Forty-two states have an external review process for medical claims. The American Speech-Language-Hearing Association strongly recommends that anyone who is denied coverage for cognitive rehabilitation fully avail themselves of all available internal and external review processes.
Fighting back paid off for a 38-year-old mother and accident victim in Montana who spent a year battling with the Blue Cross and Blue Shield of Montana. An independent claims review panel recently overturned her cognitive rehabilitation denial, setting an important precedent. The Montana Blues, following policy set by the national Blue Cross and Blue Shield Association, found cognitive rehabilitation to be an experimental treatment. While this womans victory is encouraging, her battle should never have been necessary.
In light of all the studies and the demonstrated need, there must be a dramatic increase in public- and private-sector payer coverage for cognitive rehabilitation after brain injury. Employers need to ask for these services and health plans need to provide coverage. That coverage must be of sufficient scope, duration and intensity to bring real benefit to the injured. When evidence-based research solidly supports the effectiveness of treatment, cognitive rehabilitation should be readily available to those who need it most.