Insurers outline coverage limits and coordination gaps for traumatic brain‑injury care; court ruling complicates workers'‑comp recoveries

Insurer witnesses at a joint House Human Services and Insurance Committee hearing in Harrisburg described how benefit limits, coordination of benefits and a Pennsylvania Supreme Court ruling can complicate long‑term care for people with traumatic brain injuries.

Dr. Tim Law, chief medical officer for Highmark, said commercial plans often set visit limits—commonly 20 to 30 outpatient therapy visits per therapy type—that can be exhausted within weeks for a patient needing multidisciplinary neurorehabilitation. “You can use up to 20 or 30 that's in the benefit brochure, very quickly with this,” Law said, and described a flexible‑benefit approach some insurers use to let unused visits from one therapy be flexed to another.

Why it matters: witnesses said exhausting commercial or auto benefits early can leave patients without…