The Military's Insurer Has Been Refusing to Cover This Little Girl's Therapy for Four Years
It's been more than two years since a federal administrative judge told Tricare, the Department of Defense-run healthcare program for military families, to pay for Kaitlyn Samuels' physical therapy. And for more than two years, Tricare has been stubbornly ignoring the decision.
That's Tricare's prerogative. The administrative ruling carries all the legal weight of a strongly-worded recommendation. The Samuels family responded earlier this month by filing a federal lawsuit against the Department of Defense that, if they prevail, will force Tricare to reverse itself.
Kaitlyn, now 17, is the daughter of Mark Samuels, a recently-retired Navy captain. She was born with crippling scoliosis that, left untreated, would eventually twist her spine so severely that her internal organs would be crushed.
Physical therapy can stabilize her condition, but Kaitlyn, who also suffers from cerebral palsy and epilepsy and has the brain function of a toddler, couldn't make it through a typical therapy session. Only when her physical therapist put her atop a horse -- a posture that strengthened the proper muscles in her back and torso -- did she become sufficiently engaged to make it through a 45-minute session.
In 2010 Tricare denied coverage for the horseback sessions -- and demanded reimbursement for several it had previously approved and paid for -- on the grounds that Kaitlyn wasn't receiving physical therapy, which was covered by Tricare health plans, but unproven "hippotherapy," which was not.
Why Tricare would take this position and cling to it for four years while dragging the Samuels through a soul-killing ordeal appears, after a careful examination of the facts, to have only one plausible explanation: that Tricare is a Kafkaesque bureaucracy that crushes human beings through logic explicable only to itself.
Kaitlyn's horse-based therapy wasn't costing the agency any more than a more traditional session would have. The same physical therapist Tricare had been paying for Kaitlyn's traditional sessions was also conducting the ones on horseback. Most importantly, the horse therapy worked while the other stuff didn't, a point driven home by her marked regression during several horse-free months when her family assumed Tricare had simply made a mistake.
To the Samuels -- and their physical therapist, and the administrative law judge, and any reasonable human who looked at the case -- the horse was simply a therapy tool, much like the ball or bench Kaitlyn had used before without success.
Jennifer Samuels, Kaitlyn's mother, says the lawsuit was a last resort. After their attempts to work with Tricare failed, they tried Congress. Representative Michael Burgess introduced a bill known as Kaitlyn's law, which would prohibit Tricare from denying coverage for physical therapy using horses, and they've found support from Arkansas' Tom Cotton and California's Duncan Hunter, but the legislative effort has languished as Congress has been unable to muster the oomph to aid the disabled daughter of a military veteran in her fight against a government health insurance program.
Absent legislation, Samuels hopes a favorable decision in the lawsuit will impact not only Kaitlyn's care but force Tricare to interpret its rules on physical therapy in a more reasonable way. She has also established Kaitlyn's Foundation to spread the word about military family physical therapy treatments.
To add just one more layer of absurdity to the Samuels' case, hippotherapy -- the unproven treatment Tricare maintains Kaitlyn is undergoing -- is now a covered treatment under Tricare's EHCO program, which might benefit Kaitlyn were it not limited to families of active-duty military personnel.
Send your story tips to the author, Eric Nicholson.
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