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Unmet Needs of Brain Damage Victims

I was recently appointed as Chairperson of a new committee formed by the New York State Traumatic Brain Injury Services Coordinating Council to examine the obstacles that persons with a brain injury are having in New York State to obtaining needed treatment.

In the last several years  the council has devoted a great deal of attention to services provided through the Medicaid, Traumatic Brain Injury waiver program.  The council realizes that there are many individuals who have sustained brain damage that are not eligible for the waiver and have needs that may not be fully met by the current health care delivery system.  Consequently, this new committee within the council was formed which I was selected to chair.

The council has approved the following letter which has been posted by the New York State Health Department on its health provider network to obtain information that will be helpful in examining this important area.  I ask you to please respond with relevant information.

"Dear Provider, Individual(s) with TBI and Other Interested Parties:

The Traumatic Brain Injury Services Coordinating Council (TBISCC) was formed by act of the New York State Legislature to advise the Department of Health regarding service needs of persons who have sustained a traumatic brain injury.

The TBISCC has examined a number of issues relating to availability and quality of services for individuals with a brain injury.  Recently, the TBISCC has turned its attention to the unmet needs of those who have sustained a traumatic brain injury, particularly to the obstacles to obtaining treatment and assistance through third party payers, such as:

  • Benefit Limitations (i.e. they wouldn't pay beyond a certain number of days)
  • Medical Necessity (i.e. they didn't think the services were necessary)
  • Coverage Limits (i.e. the services needed were not covered)
  • Reimbursement Limits (i.e. the plan reimbursement was inadequate to fund the services required)

Third party providers include Worker's Compensation, no fault insurance, health insurance, managed care plans or other insurance plans that provide benefits for medical care and rehabilitation following a brain injury.

We have enclosed a questionnaire which we ask you to complete and return to us concerning problems you may have encountered with third party payers in obtaining brain injury related services.  In addition, we also would welcome your suggestions for improving the delivery of services to persons who have sustained a traumatic brain injury where funds are provided by third party payers.  Please feel free to share the questionnaire with anyone you know who would also like to prove us with input on these issues."

Please return your questionnaire and other information to the Council by written communication at

Traumatic Brain Injury Services Coordinating Council
New York state Department of Health
161 Delaware Avenue
Albany, NY 12054
Attention: Dawn Crary

[You can a questionnaire by requesting one from Dawn Crary or forward your narrative experience directly to her.]

Very truly yours,

Michael V. Kaplen, Esq.
TBISCC Unmet Needs Subcommittee Chairperson
Charles Wolf, TBISCC Chairperson
Judith Avner, Esq. TBISCC, Vice Chairperson

 

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