May 21, 2012

External Review Overturns Cognitive Rehabilitation Denial

An external review board has overturned a Blue Cross & Blue Shield of Mississippi denial of cognitive rehabilitative therapy following a stroke, calling it "medically necessary." The insurer covers cognitive rehabilitation for traumatic brain injury, but denied similar coverage for rehabilitation following a stroke or aneurysm. An attorney for the patient indicated that the external review board's decision may be the first of its kind of Mississippi, and that the wording of the ruling—"cognitive rehabilitation is not experimental or investigational in nature. The use of cognitive rehabilitation is clearly medically necessary and is consistent with good medical practice for this diagnosis"—expands the possibility for treatment for others with similar conditions.


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