Military Health Insurance Will Not Cover Brain Injury Therapy

Cognitive rehabilitation therapy (CRT) is a relatively new treatment for traumatic brain injuries (TBIs). Even though it is a “young” therapy, it has garnered extensive support from both the medical and the legal community. Tricare Management Agency, the military health care provider, conducted an internal study into CRT in 2009. Tricare found no scientific proof supporting the use of the therapy and therefore refuses to cover CRT when it is the only treatment being used to  treat brain injuries. If it is coupled with another therapy, it may be covered.

Cognitive rehabilitation therapy can cost up to $50,000 for every 4-month program. Not only is the therapy expensive, it can be tremendously time consuming, based on the extent of the injury sustained by the brain. Extreme cases may require patients to relearn simple, everyday tasks.

Some in the medical community challenge Tricare’s motivation behind its study. Tricare stood accused of being more concerned with the cost of health care than the possible benefits of CRT when performing their 2009 analysis. After reviewing Tricare’s study, the lead researcher believed any new treatment would likely be rejected on a cost-control basis. Further, he recommended to military officials CRT solo coverage not be denied. Tricare, of course, denied cost being an element in their decision to deny coverage for independent CRT care.

Congressional task forces assembled with the sole focus of brain injuries annd multiple lawmakers petitioned for Tricare to cover CRT therapy.  They rely on multiple studies  demonstrating the effectiveness of CRT on patients with TBIs. Additionally, a group of military doctors supported individually reimbursing CRT therapy to the Department of Defense (DoD).

Whether Tricare will eventually cover CRT is unknown. The military requested a study into the effectiveness of CRT in patients with TBIs and if there are any specific treatments with enough support to convince Tricare to cover the therapy. This study should be completed by the end of this year.

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