E-News > January 2008
ShareJudge Recommends Coverage of Stair Climbing Wheelchair for Navy Doctor’s Paralyzed Wife
A judge has
recommended full TRICARE coverage of Deanna VanHook's stair-climbing
wheelchair, rejecting the Department of Defense's legal and policy arguments
for noncoverage of the medical device.
This recommended decision is a significant victory in the VanHook's long fight to gain TRICARE coverage of her daily-use mobility device, the INDEPENDENCE® iBOT® 4000 Mobility System, a multi-faceted device deemed essential to her ability to be mobile and take care of her two young children, the youngest of which has a significant disability. Deanna's husband Tom is scheduled for deployment to Iraq with the United States Marine Corps in the next few weeks. Note: TRICARE is the Dept. of Defense program providing medical coverage for U.S. military members and their families.
The VanHooks now await a final decision from TRICARE - which is expected to be issued before February 6.
The National Spinal Cord Injury Association (NSCIA) agreed with the judge's decision and said that there has been a disparity in the treatment of injured active duty military personnel and veterans, and their family members who survive a spinal cord injury compared to those who lose a limb.
"All military personnel with disabilities and their families need access to the kind of assistive technology that enables them to maximize their independence," said Marcie Roth, Executive Director and CEO of NSCIA. "Providing this family with an iBOT® simply fits in with the broader commitment to adequately meet the healthcare needs of our active duty soldiers, veterans and their families."
In his recommendation, the judge said TRICARE needs to improve its coverage of medical devices for military families based, in part, on the report drafted by the President's Commission on Care for America's Returning Wounded Warriors.
"The current compensation and disability systems of TRICARE require significant upgrades and recognition of the different injuries and needs that face service members and their families," he wrote. "Thanks to advances in medicine and science, changes are needed that result in increased opportunities that achieve successful transitions to productive lives by providing appropriate benefits and services."
The judge also dismissed TRICARE's rationale for denying coverage of the device, stating that it is "much too narrow and does not properly take into account TRICARE's coverage goals for addressing a beneficiary's essentials of daily living (to include companionship, recreation and transportation)."
In addition to denying coverage for this critical medical device, TRICARE also sought to deny the VanHook's request to see the judge's recommendation before TRICARE issued its final decision. That tactic was found to conflict with the Privacy Act.
Background of the VanHooks
In May 2006, Tom and Deanna VanHook requested approval for an iBOT® Mobility System under Tom's Department of Defense TRICARE healthcare coverage. To their dismay, they received repeated denials. Convinced that TRICARE should cover the device considering the agency's governing statute and its own regulations, in addition to the fact that three separate physicians expressed medical opinions in favor of coverage of the device, the VanHooks took out a second mortgage on their home and purchased the iBOT® Mobility System out of their own pocket - the only way to continue appeals and receive a hearing under TRICARE rules.
Background on iBOT® 4000 Mobility System
The INDEPENDENCE® iBOT® 4000 Mobility System is a patented gyro-balanced personal mobility system that enables users to: climb curbs; go up and down a flight of stairs with or without assistance; travel at an elevated eye-to-eye height, while in a seated position; easily fit their mobility system under a table or desk; or travel over a variety of uneven terrain, such as sand, gravel, grass or thick carpet. To learn more, please visit: www.ibotnow.com.