Legal and Financial Issues
Our first advice is not to worry about it too much.
A basic guide to the different legal and financial issues facing the family of a brain-injured person.
If your loved one is in a coma, at least in the United States, they will not be denied care, at least not until the acute stage is over. While that doesn't mean you won't have financial hardship ahead, at this point, care will continue, regardless of how the bills get paid. At least in the United States, people with severe brain injuries are not denied acute care. In fact, the people who set hospital and insurance rates understand that and all of the rest of us pay a little more, on the chance that this kind of care is needed for someone who doesn't have the ability to pay.
If you are getting hassled about medical bills while someone is still in a coma, basically tell them not to bother you, that you have more important things to worry about.
Now that having been said, getting medical bills paid may become a priority. If the person is in a coma has a family or spouse to support, then finding a source to pay these bills will help to reduce the financial hardship caused.
While there will typically be deductibles associated with this policy, after the deductible, $250 to $1000, and the copay (20% up to $5,000 typically) they should cover all acute care costs. Unfortunately, with the advent of HMO's and managed care, getting the proper care from your medical insurance company may require you to be an "advocate." The term advocate is used to mean you may have to push them, argue with them, persuade, cajole and perhaps threaten them. While every insurance policy is different, the medical insurance companies obligation to pay for necessary care is much broader than they will typically admit to.
One suggestion from an insurance professional, who is now a caregiver, is to try to get a case manager appointed. A case manager has the authority to make decisions that make sense both for the patient, and also to lessen the long term burden on the insurance company. For example, providing some in-home care, may not be authorized by the policy, but may be much cheaper than the alternative of a nursing home, which is covered.
If the survivor was injured in an accident, there is a significant probability that what we will refer to as "Med Pay Coverage", is also available. Med Pay coverage is additional insurance to cover medical bills related to the accident. Such a policy may be on the car that the survivor was riding in, any other car owned by the survivor or a member of his or her household, or on the place where the person was injured, such as in a fall. In some states, where there is no-fault or personal injury protection laws ("PIP") the Med Pay coverage may pay all the bills, but this differs from state to state.
It is a good idea to have an attorney review all insurance policies held by any member of the injured person's household, including umbrella policies, disability policies, homeowner's and even all policies on credit cards owned by the person. It may be that medical pay coverage is included in such policies.
With children, not covered by insurance, and adults who do not have substantial assets, medical assistance may be available. Medical assistance is available to someone who qualifies for SSI benefits from the social security administration. SSI, as opposed to SSDI, is available to people who do not have a substantial work history (have not paid in social security taxes in enough quarters) but who need assistance because their income and resources are below the minimum level. To understand more about qualifying for social security, go to the social security page herein.
If the survivor is eligible, medical assistance should pay all acute care costs, and substantial amounts toward long term care and rehabilitation. Medical assistance waivers, which are becoming more widely available, can sometimes be utilized to get medical assistance to cover things not typically covered by the program.
In most states, if the injury occurred at work, workers compensation is obligated to pay all related medical bills, especially for acute care costs. But as workers comp benefits are being trimmed to make states more competitive to recruit industry, an attorney may be required to force the insurance company pay all that is necessary for long term care and rehabilitation.
One final way to get medical bills paid is through a lawsuit, against someone who is legally responsible for the injury. And if you have a viable action, the survivor may recover many times the medical bills in lost wages as well. To recover in a personal injury action, the survivor must prove that someone else wrongfully caused the injury.
If an insurance adjuster is there early in the process, seemingly generously offering to pay all medical bills, don't sign anything. When faced with the pressure of catastrophic medical bills, the promise to pay all the bills may sound wonderful. Regardless of how much they try to endear themselves to you, the insurance adjuster is not your friend. He is not offering to pay medical bills out of the goodness of his heart, but to avoid paying substantially more. The insurance adjuster's job is to pay as little as he can. An early offer to pay bills is tantamount to an admission that they realize they are responsible to pay far more.
Attorney Gordon S. Johnson, Jr.
E-mail to: waiting.comWe are not medical professionals, however we encourage your inquiries regarding both legal issues and information on futher resources. Phone and email inquiries will be received by the staff of the Brain Injury Law Office, including Attorney Gordon S. Johnson, Jr.
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