In which the woman gets VERY angry with Tricare

A snippet of my letter to them in reference to another denial...

The letter goes on to state that “long term therapy may confer no advantage over short term therapy.” While we agree that the research on Autism treatment may still experimental, we are certain, however, that having no therapy at all will not be advantageous to our son at all. Every doctor and therapist that we have ever worked with agrees with this. The only dissenting party is the Tricare reviewer of our son’s case.

The letter also states, that “once a patient has reached the point where no significant practical improvement can be expected, the skills of an authorized provider will not be required.” Our son has not reached a point where no practical improvement can be expected. In fact, with additional therapy, he can be expected to make further improvements. His physicians and therapists agree with this. Again, the only dissenting body is the Reconsideration Department of Tricare.

We ask that Tricare only do what they have promised us. As an involuntarily recalled military family, Tricare is our only option for medical insurance. We have a child who has a medical need. Prior to our involuntary recall, his medical needs were taken care of by our private insurance. Now that the government has forced us to use Tricare, Tricare refuses to treat our son’s medical needs.

There is a treatment for his disorder and it is covered by Tricare according to Tricare Policy Manual 6010.54-M, chapter 7, section 18.3. We are not asking for anything more than what is already laid out in policy.

M has a loss of function due to Asperger’s Syndrome. He has not yet reached his highest level of function and will not without the appropriate therapy. We are asking that Tricare provide that therapy for him. It is very upsetting for us to have people who have never seen our child making decision that will affect the rest of his life.

The people who are active in our son’s life, his doctors, his therapists both at MCG and at school, do not feel that M has reached his highest ability. They all agree that he can make great strides if given the opportunity. As, his parents, we will do all that is possible to make sure he gets that opportunity.

Do you think they'll get that little threat at the end?
My next step is taking the newspaper article of our boys and all my paperwork into all of our Congressmen's local offices, including the potential replacements for Congressman Norwood.
One more denial...and I'm starting a Congressional hearing.
I am already bolstering up for the fight.