Medical Insurance & Cerebral Palsy: A Glimmer of Progress

Wait, what? Why is this groundbreaking? Why wouldn't my medical insurance take care of these bills?

To date, medical insurance companies distinguish between "habilitative" and "rehabilitative" therapies. Simply put, habilitative therapies are designed to teach a child new skills and maximize functional behaviors; rehabilitative therapies are designed to regain previously lost skills.

An example:

A five year old child who is injured and needs to relearn how to walk, talk, or function following an injury would be covered by medical insurance for rehabilitative therapies.

In contrast, a five year old child who is born with CP and needs assistance in learning to walk, talk, and function from day 1 is NOT typically covered by medical insurance. Insurers view these therapies as educational, not medical, and don't provide reimbursement or coverage for them.

Illinois is about to change this. Starting January 1, 2010, the distinction between habilitative and rehabilitative therapies will be erased for children with developmental disabilities up to the age of 19.

And groundbreaking? Illinois is one of three jurisdictions across the United States to mandate this change. Washington, D.C. and Maryland also provide kids with CP this same insurance coverage.

What does this mean for you?

Two possible scenarios: first, in Illinois, Washington, D.C., and Maryland, medical insurance will cover therapies for kids with cerebral palsy so long as the insurer also covers rehabilitative therapies as well. Kudos to these states for doing the right thing.

Second, less optimistic, in all other jurisdictions, parents continue to be forced to pay out of pocket for these types of therapies for their children. Research shows early therapeutic intervention is key for long-term potential in children with cerebral palsy - but if you can't pay for it, what's your other solution? Potentially a lawsuit to recover funds either from the medical insurance company to pay for these therapies OR an inquiry and possible lawsuit into whether or not cerebral palsy was caused by an injury or negligence for your child.

If lawsuit is your option, and your choice, the Rasansky Law Firm regularly represents children and families affected by cerebral palsy - and by the insurance companies unwilling to pay for necessary therapies.