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Jack Sisson's TBI Blog

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From ABC News:
Nearly three months after she was shot in the head, Arizona Rep. Gabrielle Giffords is progressing well in her rehabilitation at TIRR Memorial Hermann in Houston, where, according to her doctors, she is receiving a combination of physical, cognitive and speech rehabilitation. They say she is vocalizing more and is able to mouth the words to songs.

While Giffords is getting top-flight care at a facility that specializes in rehabilitation after major brain injuries, many patients get nothing close to it. The fine print in many health plans -- including Medicare and Tricare, which serves U.S. military members -- excludes coverage of certain types or even complete rehabilitation for thousands of patients with traumatic brain injuries, or TBIs.

"Cognitive rehabilitation services designed to improve cognitive functioning after a brain injury are not supported by reliable scientific evidence of efficacy," according to a 2008 Tricare coverage manual.

However, the manual stated that cognitive rehabilitation is subject to coverage if cognitive rehabilitation is combined with other forms of rehabilitation and "not billed as a separate service."

But the Brain Injury Association of America, a non-profit group that advocates on behalf of people with brain injuries, says studies have shown that cognitive rehab is very effective.

Experts say that despite the promising research, insurance companies provide little coverage for long-term rehabilitation, leaving many TBI patients with almost nowhere to turn to get the services they need for recovery.

"Increasingly, insurance companies are saying to health care providers, 'Don't talk to the patient about where he or she should be discharged until you talk to us first. Don't recommend a comprehensive rehab center if we don't cover it,'" said Susan Connors, president and chief executive officer of the Brain Injury Association.


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