Tricare refuses to cover TBI treatment

Using a flawed study to deny effectiveness of therapy:

During the past few decades, scientists have become increasingly persuaded that people who suffer brain injuries benefit from what is called cognitive rehabilitation therapy — a lengthy, painstaking process in which patients relearn basic life tasks such as counting, cooking or remembering directions to get home.

But despite pressure from Congress and the recommendations of military and civilian experts, the Pentagon’s health plan for troops and many veterans refuses to cover the treatment — a decision that could affect the tens of thousands of service members who have suffered brain damage while fighting in Iraq and Afghanistan.

This is a very in-depth story, centering around the plight of a Chapel Hill couple:

Sarah Wade’s husband, Ted, was a sergeant with the 82nd Airborne Division when a roadside bomb tore through his Humvee in February 2004. The blast severed his right arm above the elbow, shattered his body and left him with severe brain damage.

After the military medically retired her husband later that year, Wade struggled to find appropriate care for him. The closest VA hospital set up to handle such complex injuries was in Richmond, Va., a 320-mile drive from their home in North Carolina.

Tricare, however, would not pay for cognitive rehabilitation at a nearby civilian program.

A perfect example of why it's critical that Tricare be revamped into a more accomodating entity. Even if our VA facilities weren't overloaded, accessing local (private) providers who can give our veterans the treatment they need is the main reason Tricare was created in the first place. Congress should be ashamed of itself for allowing Tricare's bean counters to write these TBI victims off.

And while we're on the subject of money, maybe those bean counters should consider how this therapy builds a foundation for functionability and independence, and might make the difference between a veteran easing back into the workforce or remaining on disability indefinitely.

"The totality of the evidence appears to support the value of cognitive rehabilitation for people with traumatic brain injury in improving their function,” said Robert McDonough, the head of clinical policy at Aetna. “We feel on balance the evidence leads us to conclude that cognitive rehabilitation is effective."

Carriers and doctors providing the service can point to a long list of medical associations and scientific studies backing the effectiveness of cognitive therapy: The National Institutes of Health;the National Academy of Neuropsychology and the British Society of Rehabilitation Medicine, among others, have weighed in supporting the treatment.

Armed with such evidence, brain injury association lobbyists did not have much trouble finding support in Congress. By 2008, more than 70 House and Senate members had signed letters to Gates asking him to support funding for cognitive rehabilitation therapy. Then-Sen. Obama led a group of 10 senators urging Tricare to pay for therapy.