Brain Injured Vets vs. Tricare

Submitted by Lawrence Rafferty, (rafflaw), Guest Blogger


I have previously written about certain politicians wanting to reduce Disabled Veteran’s disability payments in order to reduce the nation’s debt.  Now it seems that even the Military health care system called Tricare, is balking at providing the necessary, albeit expensive, cognitive rehabilitation therapy for brain injured military personnel.  Once again, wounded vets are being taken advantage of by the very system that is designed to provide them with medical care. 

Recently, a group of 74 members of Congress from both parties, sent a letter to the Pentagon to demand that these wounded Heroes be taken care of properly and without any further delay.  Some of these same members of Congress sent a similar demand to the Pentagon two years ago and in true bureaucratic  fashion, the Pentagon and Tricare authorized a study to review the requested therapy.  I bet you are surprised that the controversial study came down in favor of not paying for this much-needed therapy!

“Rep. Bill Pascral (D-NJ) and Rep. Todd Platts (R-PA) the leaders of the Congressional Brain Injury Task Force, cited an investigation by ProPublica and NPR revealing that Tricare, an insurance-style plan covering soldiers and many veterans, had relied on a controversial study to avoid paying for the intensive and often expensive treatment.  ‘ “We hope that you share our concern that service members returning from the battlefield cannot wait to receive treatment for their injuries,” the letter states.  “It is our hope that there exists some contingency plan to provide cognitive rehabilitation for service members who are returning home today.” ‘, as reported in the Raw Story article linked below.

I do understand that money needs to be saved in all areas, even in the Defense Budget.  But, why is it that the Government and the Pentagon have the default position that the best way to save money is to hurt our wounded Heroes by reducing their benefits or blocking them from receiving the care that they so desperately need?    Is someone getting rich off of Tricare trying to avoid covering an expensive therapy that provides hope for these wounded Veterans?  These are questions that need to be answered.  However, the first order of business is for Tricare to do the right thing and cover this therapy and assist the very people who fought for our country!  Once we know that our Heroes are being properly taken care of, then we need to find out why they have been deprived of Tricare payments for this coverage for over two years, and who if any is profiting from this denial of coverage.  Call me naive, but is it possible for anyone to not agree that it is our duty to provide for all wounded Veterans with the best possible care, no matter how much it costs?

Source: Rawstory

 Submitted by Lawrence Rafferty, (rafflaw), Guest Blogger

38 thoughts on “Brain Injured Vets vs. Tricare”

  1. “This is why SS should not be privatized. When there’s that much money involved, someone is always going to be picking the someone else’s pocket.”

    Exactly, Buckeye.

    Conversely, it’s also the reason health care insurance should be nationalized: to stop the pick pockets.

  2. Humana is one of the big insurance companies for Medicare Part D (Prescription coverage for seniors). After looking a bit, it seems Humana covers only Tri-Care South. Tri-Care is divided into regions with different providers. Here is where to find a map.

    There is fierce competition for the Tri-Care contracts which should give DoD some leverage for proper coverage for their personnel.

    Humana lost the bid in 2010, then paid back the $14 million double-dipping reportedin Elaine’s article in 2010 and then got a new contract which will expire next month.

    This is why SS should not be privatized. When there’s that much money involved, someone is always going to be picking the someone else’s pocket.

  3. Woosty,
    That would be the easiest and best way to reduce the outflow of dollars, but we till have Vets who need this care.
    Lottakatz and OS,well said. It amazes me that anyone could say not to a wounded veteran who put his or her life on the line. I believe that the intentional misdiagnosis is still a problem.
    Buddha, you hit the nail on the head about Humana and their “guilt”. They felt so innocent that they thought they should pay 14 Million!
    AY and Buddha, since I am a Bears fan and there is no way that I can root for the Packers, the Steelers are going to win by a touchdown today!

  4. “Now it seems that even the Military health care system called Tricare, is balking at providing the necessary, albeit expensive, cognitive rehabilitation therapy for brain injured military personnel.”
    I would like to avoid these types of expensive therapies too….how about we stop paying for war.

  5. September 21, 2007
    Bush to Seek Lifetime TRICARE for Medically ‘Unfit’ Vets

    “The Bush administration will ask Congress to provide lifetime TRICARE coverage to any service member discharged as “unfit” due to service-related physical or mental health conditions, said Donna Shalala, co-chair of the President’s Commission on Care for America’s Returning Wounded Warriors.

    The TRICARE change will be one of the most expensive initiatives in a legislative package the White House will send to Congress by the end of September. The package is to implement key recommendations of the wounded warrior panel, also known as the Dole-Shalala Commission.

    The TRICARE proposal, if enacted into law, would open military healthcare to a wave of new beneficiaries, potentially as many as 9,000 to 10,000 newly-disabled veterans each year plus their families.

    The Dole-Shalala commission report, released in July, said the TRICARE change should only apply to service members separated for combat-related disabilities. But White House officials, at the urging of Defense officials and service associations, have decided to ask Congress to extend lifetime TRICARE coverage to all medically-discharged veterans.

    Shalala said the White House will propose that the TRICARE expansion be applied retroactively to veterans medically separated since 2001. Shalala didn’t mention a specific retroactive date but Congress two years ago made eligibility for traumatic injury insurance retroactive to Oct. 7, 2001, the day U.S. forces invaded Afghanistan and began the Global War on Terrorism.

    Under current law, members are separated rather than retired if found unfit for duty because of conditions rated below 20 percent disabling. They receive a disability severance award rather than retired pay. Because they are not “retirees,” they and their families are ineligible for lifetime TRICARE coverage. They can get VA health care but family members cannot.

    From 2000 to 2006, an average of 9,600 service members a year were separated as medically unfit with disability ratings of 20 percent or less, according to statistics gathered by the Veterans’ Disability Benefits Commission, which is due to release its report on Oct. 3. Nearly nine of 10 disabled soldiers were separated rather than retired. Sixty-four percent of sailors with disabilities, 73 percent of disabled airmen and 82 percent of disabled Marines also were released with ratings of 20 percent or less.

    Shalala and her co-chairman, retired Sen. Robert Dole, said six of 34 “action steps” that their commission recommends requires legislation. They urged lawmakers to enact the White House initiatives this fall if possible.

    In addition to expanding TRICARE, they said, Congress should:

    — Authorize the Department of Veterans Affairs (VA) to provide lifetime treatment of Post Traumatic Stress Disorder to any veteran deployed to Iraq or Afghanistan who seeks treatment. This “presumptive eligibility” for PTSD diagnosis and treatment should occur regardless of how much time has passed since exposure to combat, Shalala said. She said 500,000 service members have deployed to Iraq and Afghanistan multiple times, increasing their odds of experiencing PTSD, which “can be devastating.”

    — Strengthen support for military families caring for wounded warriors by making them eligible for TRICARE-provided respite care and aid and attendant benefits. Shalala said many families are caring for loved ones at home who are suffering from complex injuries. The families need help with around the clock care, she said.

    — Amend the Family and Medical Leave Act (FMLA) so that families of combat-injured service members see unpaid leave protection extended from the current limit of 12 weeks up to 6 months. Shalala said two thirds of injured service members have had a family member or close friend stay with them while they were hospitalized and one in five had to give up their job to do so. “That is simply unacceptable,” Shalala said. The Senate already has passed this provision in its Support for Injured Service Members Act but the House should “quickly follow suit,” she said.

    — End the dual Department of Defense and VA disability systems, by giving DoD responsibility only for finding a members unfit for duty, Dole said. DoD should pay disabled members an immediate lifetime annuity based on rank and years of service. The revised VA disability pay system should include a monthly transition payment, perhaps equal to final military basic pay. That would be replaced after the veteran settles into civilian life with payment to replace reduced earnings tied to their level of disability and payable until age 65. Veterans also should get a lifetime quality-of-life payment to compensate for life effects of their disabilities.

    The commission gave no amounts for these payments, leaving that for the Bush administration and Congress to decide.

    The commission, Dole said, recommended lifetime TRICARE coverage for any member found unfit for continued service as a result of injuries “acquired in combat, [while] supporting combat or preparing for combat. That takes [in] about everybody,” he said.

    “We think the White House is going even further,” Shalala said, “to recommend that everyone who is declared unfit for service for health reasons — that they will cover the individual and their family’s healthcare forever.”

    “The advantage of that is obvious,” she said. Disabled veterans who can work only part time still won’t have to worry about medical care for themselves or their families. “It’s a tremendous step forward,” Shalala said.

    Congress shouldn’t worry about the cost, Dole added.

    “My view was if we spent billions and billons and billions of dollars on getting young men and women in harms way, we ought to spend what it takes to get them back to nearly a normal life as possible.”

    To that remark, veterans in the hearing room broke into applause.”,15240,149951,00.html

  6. Otteray Scribe, you make a good point. It would seem that if these diagnosis were done by doctors and were deliberate then the doctors should face dome disciplinary action from their licensing boards. Certainly the affected veterans should be made whole for the harm done to them.

    A bit of good news is that Rep. Bachmann has backed off her plan to cut benefits for veterans health care:

  7. Good morning, AY.

    I’ve already placed my bets.

    The Chiefs for a no-show are solid odds.

  8. Buddha,

    Good morning….

    Sports line has GRN by 2-1/2 pts….I think its a Steelers day…total pts over/under 45-1/2…..

    a smart man would take Greenbay and 1….I like the odds of the Steelers if they win…the payout will be huge…get your bets in early as the payout goes down the closer to the game time…don’t recall how I know that…

  9. Thanks for this post you guest blogger…..

    If there is 14.5 million to be had and settled for…how many more in the wood pile….

  10. “Humana, based in Louisville, Ky., admits no wrongdoing and says there was no deliberate attempt to double-dip on its government reimbursements.”


    You don’t voluntarily settle for $14.5 million when you have nothing to hide.

  11. Insurance companies aside, one of the things that bothers me the most is the apparent deliberate misdiagnosing of members of the military when they are discharged. And with a diagnosis designed to limit liability of the VA and its insurance carriers to provide future mental health and/or medical services.

    I hate to sound like a conspiracy theorist, but there is no other logical explanation. One has to wonder what kind of pressure the DoD is bringing on psychologists and psychiatrists that might make them risk their professional credibility. We do know, of course, that some psychologists have already sold their souls to the DoD and CIA to the extent that several State licensing boards are looking into disciplinary action against them.

  12. The same problems exist in the a military care system as the public medical system? Hmmmmm, what do they have in common? Could it be that the gatekeepers are insurance companies?

  13. Elaine,
    Thanks for the links. Humana is a real sweetheart of a company, isn’t it? It seems that even injured vets are fair game to abuse in order to make a buck!

  14. rafflaw,

    From CBS News (8/16/2010)
    PTSD Soldiers Misdiagnosed: Army Said They Had Personality Disorders

    (CBS/AP) Did the U.S. Army unfairly get rid of soldiers who fought in the Iraq war after diagnosing them with a psychological condition they didn’t actually have?

    An April investigative feature in “The Nation” suggests that it did. It alleges that the US Army routinely fired hundreds of soldiers for having a personality disorder, when they were more likely suffering from post-traumatic stress disorder.

    Unlike PTSD, which the Army regards as a treatable mental disability caused by the acute stresses of war, the military designation of a personality disorder can have devastating consequences for soldiers.

    Under pressure from Congress and the public, the Army eventually acknowledged the problem and drastically cut the number of soldiers given the designation. But advocates for veterans say an unknown number of troops still unfairly bear the stigma of a personality disorder, making them ineligible for military health care and other benefits.

    From Army Times (6/28/2007)
    Filner says PTSD misdiagnoses cheat vets

    The chairman of the House Veterans Affairs Committee plans a summer attack on the military’s disability review system, hoping that congressional hearings focusing on what he called the “terrible scandal of deliberate misdiagnosis” of mental health problems could lead to an overhaul of government policies.

    Rep. Bob Filner, D-Calif., said he expects to have veterans testify they were improperly diagnosed as having pre-existing personality disorders rather than post-traumatic stress disorder, a move that denies service members military disability benefits and could, under some circumstances, even leave them with no post-service veterans’ benefits if their mental health problems have led to misconduct, such as abuse of alcohol or drugs.

    “This is a real scandal, in my opinion, to save a few dollars … that wrecks lives,” Filner said Thursday in a meeting with reporters to talk about committee plans.

    Dates for the hearings have not been set, but he mentioned August — when Congress generally takes a break — as a possibility in order to draw extra attention to the testimony.

    Filner accused the military of “purposeful misdiagnosis” and of misleading service members into believing that accepting a pre-service personality disorder as the root of their problems would still leave them with government help.

    “There were lies, real lies,” Filner said.

  15. rafflaw,

    Thanks for posting this story. I had never heard of Tricare. here’s some information I found about Tricare. It’s an insurance program run by Humana.


    Humana Military: Healthcare Services

    Humana to repay government $14.5 million for double-dipping Medicare fees

    Humana Inc. will pay $14.5 million to the federal government for what investigators allege was the HMO’s deliberate scheme to defraud the Medicare system.

    Officials with the U.S. Attorney’s Office in Miami, which investigated the HMO’s payment records, accuse Humana of double-billing the government over an eight-year period by classifying thousands of its patients as eligible for both Medicare and Medicaid. That so-called dual eligibility allowed Humana to collect higher payments, officials contend.

    Humana, based in Louisville, Ky., admits no wrongdoing and says there was no deliberate attempt to double-dip on its government reimbursements. Humana is one of the nation’s largest publicly traded managed care companies, with about 6.2 million customers.

    The $14.5 million settlement, reached on June 5 and announced the next day, is the first in the nation involving a Medicare HMO. A tentative settlement was actually reached a year ago but not finalized until now.

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