A few days ago I received a copy of the Complaint (lawsuit) filed in US District Court in Washington, DC, against the United States Government, the Department of Defense, Tricare Management Activity, and Secretary of Defense Robert M. Gates. You can read the Complaint HERE. Most of the letters cited in the complaint can be found in the Documents section here on Autism Salutes (scroll down on the left side).
As a parent who worked on and continually wrote about what was happening with the legislative efforts mentioned in the Complaint, I have been very aware for years that the reason the DoD set up the ECHO program the way they did was to avoid paying for the expensive therapy that benefit our children with autism. That would be ABA therapy.
Since the Complaint was filed in US District Court, TRICARE Management Activity issued a letter on June 30, 2010, to the CEO’s of all its’ contractor’s, one of which is Humana. You can read the letter HERE. The letter stated that TMA was reviewing its policy on whether or not they would provide ABA under the basic Tricare program and that they expected to have this review completed by September 20, 2010. The letter also stated the contractor’s for TMA were to hold in abeyance until the review was completed; claims filed and authorization requests, for ABA. That means NO MORE DENIAL LETTERS for claims or authorization requests are to be SENT until the review is complete. Keep in mind, the letter from TMA was issued June 30th. On July 8, 2010, a denial letter was issued by one of TMA’s healthcare contractor’s.
All I can think of after reading the Complaint is that what the DoD has gotten away with, for YEARS, is criminal. There has been a complete lack of “checks and balances”. I’ll tell you honestly, I think the DoD under estimated military spouses and members who have spoken up to bring this about. I also think they have under estimated parents of children with autism across the ranks, and when I say that I mean those in the civilian world as well. We don’t put up with perfidy, and we certainly don’t tolerate crimes against humanity, which is exactly what has been committed by the DoD, and against CHILDREN! As a good friend of mine stated in a comment post the other day, “the genie is out of the bottle”.
I am of the belief that those in government who have not supported our military families who have dependents with autism, these two “gentlemen” (pictured to the left), and the CEO’s of the healthcare contractor’s for TMA, should all be brought up on UCMJ charges or the civilian equivalent of such. Should this happen, they should each be sentenced to one year in the Brig or Prison for each child they; denied a claim for, denied an authorization for, and the number of years collectively that a child was not able to access ABA under their “ECHO” program because providers were not available under the program. Essentially, a life sentence for each of them; that’s what they’ve done to countless children, sentenced them to a life in the prison of autism.
This time, there is no more smoke screen, and the letter from TMA to the contractor’s was nothing more than that. If it was anything more, then every single employer at every Tricare contracted healthcare organization would be aware of what they had been instructed to do by DoD and TMA, and yet 20 days later they still don’t have a clue.
Yes indeed, "the genie is out of the bottle".
4 comments:
We are newly retired, with a 11 year old with autism. He was getting ABA while we had ECHO. Now that we are retired, we have to pay for it out of pocket. Our therapist is giving us a discounted rate, while we figure out what we are going to do. Discounted is still more then we can afford, but we have cut his hours down to 4 hours a week. Should we still have them bill Tricare, even though they won't pay while this is being considered? Please help we are desperate for him to get the only thing that has helped him.
We are AD and have not enrolled in ECHO yet. We just haven't had time yet, what with the speech therapy, IEP issues, and looking into homeschooling (Which are a HUGE underrepresented block of autistic children as their numbers aren't counted at all!) We are actually looking into doing Son-Rise, it has a similar success rate as ABA, and while the costs are large up front for the training, you do the therapy yourself and can save hundreds of thousands over the course of years. Unfortunately, as this is a "breakthrough" (meaning new) treatment, it isn't sanctioned by TriCare ECHO and will not likely be available for re-imbursement for years down the road, which could potentially save the military thousands for parents that are willing/able to invest the time and energy to learn and implement it in their own homes (not that we don't have enough to do as military families with special needs children!) We have looked into ABA, and while a great therapy, it isn't the BEST fit for our child, IMHO. My point is, that ALL therapies available are under/not funded- (including biomed! Although I am lucky we live in a place with a Tricare authorized DAN! Doctor and we can work around MOST of the RED tape-excluding supplements)
I just hope that miltary health care gets on the prevention and remediation bandwagon before our children are all products of a broken medical system with an endless cycle of fixing what is broken and breaking something else in the process....
what has become of the lawsuit? any news and updates would be appreicated. We are ADAF and due to retire in October 2011 and have an 8 year old son with severe Autism. Right now he is getting 10 hours a week of in home ABA through ECHO but we are so worried on what will happen when we lose that benefit. MA has signed the ARICA 207 bill but it is still so new no one knows what it really does, how it works or how it will effect us.
Thanks
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