TRICARE Will Not Pay for Cognitive Rehabilitation

Cognitive rehabilitation therapy (“CRT”) retrains the brain to perform basic tasks like counting, memorization, word recall, remembering directions, and cooking.  It is believed by many in the medical and scientific field that this type of therapy can help those who have suffered head trauma.  However, TRICARE, the insurance-type program that covers approximately 4 million active duty service members and retirees, has denied coverage for CRT for brain injuries.

The Pentagon made this determination based upon an internal 2009 study by the TRICARE Management Agency.  It concluded that the study revealed insufficient evidence to show that this form of therapy is effective in treating traumatic brain injury (“TBI”).  However, TRICARE does cover speech, occupational, and other types of therapy for TBI which are often a part of cognitive rehabilitation programs.    

CRT is lengthy and costly.  It has been estimated to cost up to $50,000 for a four month program, and patients can spend up to 30 hours a week in therapy.  TRICARE’s 2009 study has been criticized by some doctors as an attempt to control spending, though this is denied by TRICARE officials.  Others fault the study for not following the recommendations of a Pentagon panel of more than 50 experts, other studies, and health organizations that all support the treatment.  The Pentagon decided to deny coverage for CRT despite Congressional support to cover it – which included more than 70 letters to the Secretary Defense and the creation of a Congressional Brain Injury Task Force, which supported CRT.  While still in Congress, President Obama led a group of 10 senators advocating for TRICARE to pay for CRT.  Many Veterans organizations, such as the American Legion, have also come out in support of reimbursement for CRT.

The National Academy of Sciences’ Institutes of Medicine – the same organization who researches the relationship between herbicide exposure and various conditions – has been requested to study the effective of CRT as TBI therapy and determine whether scientific evidence supports TRICARE coverage for any specific treatments.  This review is not expected to be finished until the end of 2011.

For more information, see the investigation by NPR and ProPublica, available at:  http://www.npr.org/2010/12/20/132145959/pentagon-health-plan-wont-cover-brain-damage-therapy-for-troops.

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