Tricare Management Activity: Accept the decision of the judge whom they hired and paid to hear our case
My husband has served on active duty in the Navy for over 20 years. Our severely disabled daughter, Kaitlyn, was receiving physical therapy services which were approved and paid for by Tricare. After over one year, Tricare stopped coverage of her therapy and recouped all previous payments due to the fact that it was determined Kaitlyn was receiving "hippotherapy". Kaitlyn's physical therapist was using a horse as a therapy tool rather than a ball or a bolster, but she was still receiving only physical therapy. This was noted in every PT note the therapist submitted to Tricare for payment and the intent to use the horse was included in the physical therapy evaluation summary also submitted to Tricare prior to payment. We appealed this decision and ultimately had a hearing in February 2012. The judge was chosen and paid for by Tricare. We paid our own attorney fees. The judge found in our favor, however, Tricare disagrees and continues to deny coverage. We followed the appeals process that was required of us and Tricare needs to accept the decision of the judge they hired and provide coverage for the therapy Kaitlyn is entitled.
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