Military insurer denies coverage of new brain injury treatment

By Andrew Tilghman, Military TimesMilitary health officials are refusing to pay for a new treatment for traumatic brain injury despite widespread support for the therapy among doctors and lawmakers.In an internal 2009 study, the Tricare Management Agency found that cognitive rehabilitation therapy is scientifically unproved and does not warrant coverage as a stand-alone treatment for brain injuries.

"There is insufficient, evidence-based research available to conclude that cognitive rehabilitation therapy is beneficial in treating traumatic brain injury," Tricare said in a statement to Military Times.

The therapy is costly and time-consuming, often requiring one-on-one help for patients to relearn basic life skills involving language, math and memory. It's estimated to cost up to $50,000 for a four-month program.

Tricare said some cognitive rehabilitation therapy, also known as CRT, can be covered for troops when it is wrapped into other forms of treatment, but it cannot be billed as a distinct and defined medical service.

Details of Tricare's 2009 analysis were first reported by National Public Radio on Dec. 20.

Some doctors criticized Tricare's analysis, saying it reflects underlying concerns about health care spending.

"It seems to me this is motivated by an effort to control costs, that anything quote-unquote 'new' is going to be denied," said Dr. James Malec, a research director at Rehabilitation Hospital of Indiana. Malec reviewed the Tricare study at the request of military health officials last year and said he opposed the decision to deny coverage for CRT.

In a statement, Tricare officials denied that cost played any role in the decision: "Tricare decides whether or not to cover a treatment based on the demonstrated safety and efficacy of that treatment."

In 2008, dozens of lawmakers from Capitol Hill sent a letter to Defense Secretary Robert Gates urging Tricare to provide coverage for CRT. Lawmakers also formed a Congressional Brain Injury Task Force, which supported the therapy as well.

"Study after study has shown the efficacy of cognitive rehabilitative therapy in improving the health and functionality of TBI patients," the task force wrote in a letter in October 2009.

Also in 2009, a conference of military doctors recommended that the Defense Department consider "cognitive rehabilitation as a separate reimbursable rehabilitation technique for the traumatic brain injured with persistent cognitive deficits."

The formal policy on coverage of CRT remains under review, Tricare official said.

The military has asked the National Academy of Sciences' Institutes of Medicine to study the effectiveness of CRT in TBI cases and identify specific treatments that may have enough scientific evidence to warrant coverage by Tricare. Officials say that review will be completed by the end of 2011.

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