Response to Tricares Change in ABA Policy from Senators Gillibrand and Murray

TricareLogoThis is an incredible response that nails every point that my wife and I were discussing last night after learning of the discouraging Tricare news. Please click on the link below to read their response to Tricare’s ABA radical policy shift.

Such an egregious shift in policy such as this must be an attempt to fire the proverbial “shot across the bow” to all Tricare ABA beneficiaries. Tricare, through careful, deliberate planning, sends a powerful and surprising position change that is so radical all the while knowing they will receive a push-back exchange from their beneficiaries. They do so in order to gauge the DEGREE of return response they will receive from those relying on the benefit (aka – all the “smaller ships”). From a public affairs standpoint they are now collecting response data from the announcement in both quantity and quality as they aren’t truly ready yet to make the real change. Reading the change announcement itself leaves one to scratch the head until near bloody as it is so full of missing components, all of which are taken to task from this Gillibrand/Murray response.

Now, my speculation is that Tricare will back peddle as the response from thousands of smaller ships, their senators and others continue to rally and rail against the change. While at the same time of gauging the DEGREE of outcry, they will then go back to the planning table with all the new data we are providing them, in order to better prepare for the gentle downsizing, disruption and eventual discharge of ABA benefits to thousands. Tricare will be back again, but expect a back peddle in the weeks or perhaps months ahead. The more data, the longer they will delay.

Very, very unfortunate for the families of the brave men and women who serve and the dependents who rely heavily on those necessary, appropriate, medically-necessary benefits for development!

In Advocacy,

Mike

Response to The Tricare Response in Losing Retiree Lawsuit

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.”

Aetna Insurance Fined $1.5M For Denying Autism Coverage

It was inevitable that a warning shot like this would eventually be fired at health insurance providers who continue to deny (or make extremely difficult) coverage for autism-related services such as ABA. I am eager to see how this resonates across the states with mandates, especially with several that are rallying support to appeal autism mandates passed in recent years. Again, this goes back to the debate on who is ultimately responsible for footing the bill for necessary interventions such as ABA for children with autism. Perhaps this will set a precedent in other states who do not abide by their state’s mandate. Click here to read about the fine against Aetna in Missouri.
In advocacy,

Mike

The Berge Family Victory For ABA for All Retirees!

We are so proud of this family who fought the good fight and won! What a precedent they have set. We have yet to see, ultimately, how Tricare will respond, but suffice to say that RETIREES NOW GET ABA COVERAGE FOR AUTISM!!

Please take a look here and Google on the internet to learn more, especially with AMFAS Facebook page for updates!

In Advocacy,

Mike