Rehabilitation limits the burden of disability on patients; families, the long-term interest of patients, insurers, and society at large. Most patients can benefit from rehabilitation at all stages of their treatment, even if months after the initial injury. To be effective it should begin very early. Patients benefit through improved length and quality of life, increased independence and restored earning power over their work life; government gains through decreases in state assistance, and insurers and the consumers benefit through decreased medical and nursing home costs.

While studies show that rehabilitation cuts substantial reductions in hospital stays and re-admissions, particularly if rehabilitation is begun early in the patient's acute care, often insurance or state funded health care programs do not approve rehabilitation care needed to restore the patient to independent living.

Many insurance companies, as well as state programs, are adopting managed care plans as a way to provide care. while at the same time controlling cost. In these plans, the role of gatekeeper or primary care physician is crucial as that person may be the one who determines if your family member receives rehabilitation services, such as speech therapy, occupational therapy, physical therapy, counseling and cognitive therapy.

If you have insurance, it is recommended that you review your insurance policy to check benefits covered under the plan. If you have insurance or if you do not have insurance, it is also recommended that you pursue the first two recommendations immediately:

1. Contact your county Division of Family Services office to determine eligibility for Medicaid, and/or income maintenance, and food stamps. For some individuals who are injured they will need rehabilitation and long-term care or supports for a period of time after hospital discharge and others may need them over a life time. Insurance may not cover all of these services. Also, some state agencies may require Medicaid eligibility or proof of ineligibility in order to receive their services.
2. Make application with the Social Security Administration for Social Security Disability Income (SSDI) and/or Supplemental Security Income (SSI).
3. Review your insurance policy particularly with regard to the following:
   • Does the plan cover the following therapies and are the therapies limited by days or amounts?
     • occupational
     • physical
     • speech/language
     • cognitive
     • behavioral
   • Does the plan allow transfer to CARF (Commission on Accreditation of Rehabilitation Facilities), a nationally accrediting agency setting national standards for care approved rehabilitation centers?
   • Does the plan include long term care benefits, such as in-home support?
   • Check the plan on its due process for members should you wish to challenge payment for health or rehabilitation care.

The Missouri Department of Insurance consumer affairs number is 1-800-726-7390. You may call that number should you have problems or questions regarding your health insurance company.

(Taken from BIA of Missouri)