Pentagon Refuses to Pay for Horse-Riding Therapy for Disabled Daughter of Navy Officer

Friday, December 07, 2012
Kaitlyn Samuels (photo: The Atlantic)

The U.S. military’s health insurance program is willing to pay for a young girl’s physical therapy, but only the kind that doesn’t work, and won’t cover the kind that does work and could save her life.

 

Kaitlyn Samuels, 15, was born with a rare neurological disorder similar to cerebral palsy that, without effective physical therapy, will eventually result in her own body crushing her internal organs, resulting in death.

 

Her father, Mark Samuels, a U.S. Navy officer, was able to get Kaitlyn medical treatment through the Department of Defense’s healthcare program, TRICARE. But her doctors found that traditional forms of physical therapy didn’t work for Kaitlyn, leaving them to try an alternative: horseback riding.

 

Spending twice a week atop a horse proved effective for Kaitlyn, as the riding helped stretch her muscles and straighten her spine.

 

For a while, TRICARE covered the horseback riding therapy, which is dubbed “hippotherapy.” But, then, the military decided hippotherapy was unproven and refused to pay for the sessions. Even worse, TRICARE demanded the Samuels pay the government back for the sessions it had covered.

 

“TRICARE made it clear that it would pay for Kaitlyn’s physical therapy if it was the type that wasn’t working on Kaitlynn—traditional physical therapy—but wouldn’t pay for the type of physical therapy that did work on Kaitlyn,” wrote Andrew Cohen at The Atlantic.

 

Hippotherapy is covered by Medicaid.

-Noel Brinkerhoff

 

To Learn More:

The Pentagon Says No to Disabled Daughter of Navy Captain (by Andrew Cohen, The Atlantic)

A Navy Captain's Increasingly Absurd Fight Against Military Insurer to Pay For Disabled Daughter's Physical Therapy (by Eric Nicholson, Dallas Observer)

Disabled Girl's Treatment Coverage Depends on Definition of "Hippotherapy" (by Leslie Minora, Dallas Observer)

Comments

Lynn Johnson 11 years ago
This is MURDER! We have been subject to the same failed process! Why don't military members have the same protections under the PPACA act? Shame on our government and all those involved. Shame on those who reverse, deny and then arbitrarily and capriciously discriminate against sick beneficiaries like myself and Kaitlyn Samuels. My husband no longer proudly serves his country but counts the days until he may retire knowing that every day his family is being withheld proper medical treatment. I have been in contact with not only the reporters who have done an amazing job shedding light on these issues but also the Samuel family. I pray to god that not only does the care in question (that is, only questioned by Tricare/DoD lawyers) will finally be covered but that the person working on our DoD IG investigation will discover, that above and beyond specific care, (that Tricare makes it impossible to navigate or to be successful in arbitrating) that the DOD IG investigation will discover that Tricare (through contractor like Healthnet) is arbitrarily and capriciously delaying and/or denying all care/claims to beneficiaries who exercise their right to appeal. That this will shed light on the flawed appeals process, the flawed process in which lets Tricare contractors twist the words in federal regulations to defer and ultimately deny legitimate medical claims. A flawed process that lets Tricare decide the ultimate faith of life or death, regardless of an outcome of the appeal hearing. If this were any civilian insurance company this would not be tolerated or allowed. The PPACA act protects civilians but leaves our military families at the mercy of the flawed process. It lets them die. This is not about the specific appeal or the Samuel's need for physical therapy for their daughter. It's about flaws in the system. It’s about Tricare and their contractors making mistakes but nobody taking accountability. Fix the process that lets Tricare official's like Mr. O'Bar play GOD! Do you really think that the Samuels went through a three part appeal, which included spending more than $5,000 on legal representation over $1,300 worth of claims if it wasn't about what is morally and ethically wrongdoing? Please pray for the Samuels and families like ours, that the Armed Forces committee will get involved and will hold Tricare accountable for breech of contract. Hopefully they will amend legislation and/or will support new legislation that protects our beneficiaries. Legislation that doesn't allow Tricare and their contractor(s) (ie: health net) to twist and manipulate it to deny medically necessary care. Legislation that will give our military members the same rights and protections that give every other American under the PPACA act.

Leave a comment