A guide to health insurance after stroke or other neurological injury.
Health insurance is a complicated and expansive topic. In this article, we’re going to cover the two types of health insurance, what covered services you should check for, and key questions to ask your insurance carrier after stroke.
The 2 Types of Health Insurance
First, let’s start by identifying the 2 types of insurance: indemnity insurance and managed care plans.
Indemnity insurance involves a deductible, which is an amount that you pay toward your medical expenses before insurance pays. Once your deductible is met, your insurance will start paying for covered services. You can find your insurance’s covered services listed in the material your insurance company sent you. Indemnity insurance also requires that you fill out and submit claim forms to receive your benefits.
Managed care plans provide reduced costs for health care services provided by doctors and facilities that belong to their plan. All medical costs are covered except a small co-payment that you pay each time, which makes your out-of-pocket expenses less. However, your choice of providers and facilities are limited to those within the network, and if you see a therapist outside of the network, you will probably pay full price.
Managed care plans can be further categorized into 2 types of plans: Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). With an HMO, you usually have to get a referral from your doctor in order to see a specialist. Under a PPO, you can bypass the referral and see any specialist within the network.
Services to Check For
Rehab can be expensive, so contact your insurance carrier and ask if they cover any of these rehab services:
- Acute care, also called inpatient care, and rehab hospitals provide 24-hour medical care and a full range of rehab services in a hospital setting. These facilities can be very expensive because they provide continuous care by highly trained specialists and provide amenities similar to a hotel, like food and sleeping arrangements.
- Sub-acute facilities provide daily care and a wide range of rehab services but you’ll receive one or two hours of therapy a day instead of the 24/7 care that you receive in an acute care facility.
- Long-term care facilities, or skilled nursing homes, provide rehab services several times a week to long- and short-term residents.
- Outpatient facilities provide rehab services to survivors who live at home and can come to the center for treatment several times a week.
- Home health agencies bring rehab to you by providing services in your own home.
Questions to Ask Your Insurance Carrier
Along with checking for those services, here are other questions that you should ask about your coverage.
- At what point will my plan require me to pay out-of-pocket?
- Do I need a referral to see a specialist?
- Are my doctors and facilities in the provider network?
- Does my plan cover prescription drugs?
- What type of medical equipment is covered?
- What percentage of the cost for equipment is covered?
- Does my plan limit the number of days that I can see my therapist?
- Do my number of covered visits renew every year?
- Does my plan limit the dollar amount that it will cover for services?
- What are the procedures for an appeal?
Once you can gather all the information that you need from your insurance carrier, you can talk with your case manager or other rehab specialist about your covered services. You can also discuss what type of services and/or devices are worth paying out-of-pocket for.