Cognitive Therapy Denial Overturned

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A significant success was achieved through an external review board’s reversal of Blue Cross and Blue Shield of Mississippi’s denial of cognitive rehabilitation benefits for James Butler following his stroke. Mr. Butler suffered a series of strokes which left him with a residual right hemiparesis, speech and cognitive deficits which impaired his ability to function independently and compromised his safety. Mr. Butler’s wife, Mary Hawkins Butler, the mayor of Madison, Mississippi realized that her husband needed continuing rehabilitation following his initial inpatient and outpatient care. The Butler case began in 2006 with a letter from American Speech and Hearing Association, a long time advocate of cognitive rehabilitation, to Blue Cross Blue Shield Association which provided data from the ASHA National Outcomes Measurement System and other supports for cognitive rehabilitation.

This case paves the way for other in a similar situation. Blue Cross covers cognitive therapy for traumatic brain injury but has denied cognitive therapy following a stroke or aneurysm. The external review board ruled that “cognitive therapy is not experimental or investigational in nature”. Blue Cross has removed its 2008 report from its website which called cognitive therapy “investigational”.

Its been a long battle with insurers to recognize that cognitive therapy is part of medical rehabilitation. Mr. Butler’s successful appeal is part of a well-deserved victory.

Click here to read the story from The ASHA Leader

http://www.asha.org/Publications/leader/2012/120828/Cognitive-Rehabilitation-Denial-Overturned.htm

About Rolf Gainer Ph.D.

Dr. Rolf Gainer is the founder of the Neurologic Rehabilitation Institute at Brookhaven Hospital in Tulsa, Oklahoma as well as the Neurological Rehabilitation Institute of Ontario, in Toronto, Canada. Dr. Gainer is a psychologist with more than twenty-five years of experience in the treatment and rehabilitation of individuals with brain injuries and a dual diagnosis. Dr. Gainer has designed and operated innovative rehabilitation programs in the United States and Canada for individuals who have been regarded as difficult to serve. He is currently involved in conducting two outcome studies related to the long-term issues faced by individuals with brain injuries and a dual diagnosis. He has presented papers throughout the United States and Canada in many professional conferences and educational forums.
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