This is the kind of stuff that really riles me up in a big way. Any parents who has ever advocated for their autistic child know that sickening, angering and gut wrenching feeling when your child’s rights to proper care or education are denied. It is even worse when the matter goes to court. My wife and I have been there multiple times in due process and state complaints, and have watched the bureaucracy and politics that occur with governmental organizations that do not want to comply with the law.
Such is the case, as it appears with the recent ruling against Tricare that was awarded to a family that challenged Tricare to their policy of not providing applied behavior analysis, or ABA for their child as military retirees who utilize Tricare for their health care provider. It took several years, but earlier this year the judge in the matter ruled that Tricare needed to cover ABA as a medical benefit, regardless of programs like ECHO and the Demo that are provided to active duty military. Well, as this article attached below states, the family won, but what did they really win?
Because Tricare legally now has to cover ABA for the thousands of retirees and their autistic dependents, they have also decided that they will start changing the rules as to who can and cannot now receive ABA for active duty dependents as well. It appears that Tricare has started to deny ABA benefits to those with Down Syndrome, when that was a regular benefit before the lawsuit. I know it will not end their with the animal known as Tricare.
The main PROBLEM in all of this is that the current platform in this election season by the incumbent president is that “voting for the Republicans will hurt those with Autism or Down Syndrome.” Well, sorry Mr. President, and sorry President Clinton (who said these very words during the Democratic National Convention) but YOUR administration is already doing a good job of disrupting and damaging the lives of military dependents who rely on those services.
There is going to be much more on this issue to come.
Please click on the link here to read the rest of this story. Here is an excerpt from it….
“…And so I was shocked when, only one month after he started treatment, I received a letter from Tricare refusing to pay. I appealed, appealed and appealed. I was denied, denied and denied. Tricare, we were told, covers no therapy – medically necessary or otherwise – for retirees.
Tricare insisted that the most – and almost always only – effective autism treatment was not a covered benefit. In one phone conversation, a Tricare representative hissed: “If you don’t like the way the legislation is written, then contact your Congressman.”
Which I did.
I appealed to my congressman who took up my cause. He, too, was rebuffed. I appealed to the number two in charge of Tricare, Gen. Elder Granger, and was rejected again.
Finally I appealed to the Secretary of Defense. Like everyone else in the Tricare bureaucracy, a curt rejection, with little or no explanation, was his response. I felt defeated.
And that’s when we headed to court.”