Insurance Basics for Stroke Survivors

Having a stroke is expensive, potentially costing tens of thousands of dollars for acute care and stroke rehabilitation services. Your health insurance can decrease your out-of-pocket costs drastically, so it’s worth your time to get familiar with your coverage and learn how to advocate for yourself to maximize your benefits.

Knowledge Is Power: What Benefits Should You Get?

When you know what your insurance will pay for, you can avoid unpleasant surprises later on in the process. Spending a few hours reviewing your health insurance coverage is a valuable investment of time for a stroke survivor. Policies vary, but your health insurance may offer partial or full coverage for the following stroke rehabilitation care :

• Inpatient care and associated therapies
• Home health nursing, therapies and social work
• Outpatient physical, occupational and speech therapy
• Medication
• Stroke orthotics (e.g. arm, leg or ankle braces that help to restore functioning to affected body parts)
• Some mobility equipment

Most health insurance plans cover at least a portion of the costs associated with stroke rehabilitation and adaptive equipment, but patients can expect to share some financial responsibility as well. You’ll want to become familiar with the following insurance terms that you may encounter in this process:

• Deductible – a set amount of money that patients are responsible for before insurance coverage kicks in.
• Co-pays – A set dollar amount that patients pay per office visit or service received after the deductible has been met.
• Co-insurance – A percentage of the billable amount that is the patient’s responsibility, after deductible has been met.
• Out-of-pocket (OOP) maximum – The highest amount of money that the patient is expected to pay for care in a one-year period.
• Lifetime coverage limits – These are rare, but your insurance policy may place a limit on the total dollar amount that it will pay out for stroke-related care.

Advocate For Yourself To Get Your Entitled Benefits

Unfortunately, errors by both providers and insurers can cause unnecessary stress as you are trying to focus your energy on your recovery. If you do encounter one of the issues listed above, you can advocate for yourself or enlist help as needed. Get acquainted with the Patient’s Bill of Rights (https://www.stroke.org/en/life-after-stroke/recovery/managing-your-stroke/finances-insurance-and-assistance/patients-bill-of-rights) so that you know the coverage you should have. If you don’t get the response that you want from your insurer despite your best efforts, consider consulting a professional for further assistance. The following resources can be helpful in this effort.

• Patient Advocate Foundation – https://www.patientadvocate.org/
• Medical social workers
• Social workers or case managers employed by health insurance companies
• Private pay care managers

When you’re recovering from a stroke, you want to focus your energy on stroke rehabilitation, not fighting with your insurance company. Be a strong advocate for yourself, and tap into professional assistance as needed to help you navigate this complex system.