Choosing Insurance & Rehab Coverage: A Guide for Trauma Survivors and Caregivers

It’s open enrollment season—time to make decisions that impact your recovery.
After a traumatic injury, choosing the right insurance coverage can feel overwhelming. But with the right plan, your recovery doesn’t have to be.

After a serious injury, survivors and caregivers face more than physical healing. Insurance questions, coverage gaps, and administrative hurdles can quickly become major sources of stress.

Whether you're reviewing your current plan or considering a change during open enrollment, here’s what to look for—and how to get help when you need it.

Start with What You Have

The first step is understanding what kind of insurance coverage you have and how it supports recovery-related needs like rehab, therapy, mental health, and equipment.

Types of coverage to consider:

• Employer or Marketplace (ACA) Plans
  Often include both inpatient and outpatient rehabilitation, but services may require prior authorization or have visit limits.

• Medicare
  Covers inpatient rehab, skilled nursing, and home health care—with specific eligibility criteria and caps.

• Medicaid
  Coverage varies by state and may include extended therapy, equipment, and home supports.

💡 Request your Summary of Benefits and Coverage (SBC). This one-page overview explains what’s covered in plain language and can help you anticipate and plan for care needs.

Key Benefits for Recovery

When evaluating your options, these coverage details often make the biggest difference:

• Therapy session caps: Some plans limit annual visits for physical, occupational, or speech therapy.

• Durable medical equipment (DME): Understand what’s covered, from wheelchairs and braces to prosthetics and assistive tech.

• Mental health: Federal law requires equal coverage for mental and physical health, but the specifics still vary. Look for access to trauma-informed providers.

• Out-of-pocket maximum: This number can help you budget and avoid unexpected expenses if care needs are high.

💡 Open enrollment is a valuable window for reviewing your options and switching to a plan that better fits your situation.

Questions to Ask

Bring these to your care team, insurer, or case manager:

• How many therapy sessions are covered annually?

• Are home health services or equipment, like wheelchairs and mobility aids, reimbursed?

• Which mental health providers are in-network, and do they specialize in trauma?

• Is prior authorization needed for certain rehab services?

• What’s the process for appealing a denied claim?

What if Coverage is Denied?

Even with strong plans, occasional denials or misunderstandings can occur. If they do:

• Request a written explanation: Insurers are required to explain the reasoning behind a denial.

• File an appeal: Many are resolved quickly once more documentation is submitted.

• Involve your care team: Providers can submit the clinical details insurers need to reconsider.

• Track your progress: Apps like TandemStride can help document recovery milestones and show ongoing medical need.

💡 Many recovery programs—including TandemStride—can support you in navigating this process. You don’t have to figure it out alone.

Recovery is a Team Effort

The best outcomes happen when healthcare providers, insurance partners, and support networks work in sync. Insurance is part of your recovery ecosystem—and understanding it can help you make informed, empowered decisions.

We work closely with health systems and insurers to ensure survivors and caregivers have access to the tools and advocacy they need to stay engaged, track progress, and move forward with clarity and confidence.

For survivors and caregivers:
Use the TandemStride app to track rehab milestones, log questions, and connect with peer mentors or mental health support.

For providers and care teams:
TandemStride complements your care and helps patients stay engaged long after discharge. Partner with us to extend that impact.