Wheelchair is a medical need, judge rules

The doctors have agreed from the beginning, and now Deanna and Dr. Tom VanHook have a military judge on their side. They all say a high-tech wheelchair called the iBOT 4000 Mobility System is medically necessary for Deanna, who was paralyzed in an auto accident in 1984.

Still, the VanHooks are awaiting the final word from Tricare on whether the federally funded health benefits plan for active duty military members will reimburse them.

The decision is expected in February, almost two years from when the VanHooks' battle with Tricare over the chair began. It culminated in a hearing in August at the Department of Defense after repeated Tricare denials.

"The bottom line is it's the ambiguity that's causing all the heartache," said Tom VanHook, a Navy physician who could deploy to Iraq soon. "I'm more interested in the principle than the reimbursement."

Tricare has maintained that the iBOT is a luxury that it is not obligated to cover. The VanHooks, Deanna's doctors and an independent medical reviewer have argued that the chair - which allows her to go up and down stairs and follow the couple's two young children over rough terrain - is a medical necessity.

Late last year, the administrative judge at the Department of Defense who presided over the August hearing agreed with the VanHooks that Tricare should reimburse the cost of the nearly $25,000 chair.

The "beneficiary's medical condition and family circumstances are such that the device is medically necessary and appropriate for her use," Administrative Judge Roger C. Wesley wrote in his decision.

The decision, however, is nonbinding. Tricare could continue their refusal to reimburse for the chair, which the Portsmouth couple took out a home equity loan to cover in March. Deanna VanHook's shoulders were severely damaged after more than 20 years pushing a manual wheelchair.

Tricare officials declined to comment on the case. They cited a policy of patient confidentiality. The VanHooks provided official documents to The Pilot, including Wesley's decision, which outlines Tricare's position.

Part of the argument for Tricare reimbursement is that the Department of Veterans Affairs has approved coverage of the iBOT. At the time of Wesley's decision in November, Independence Technology, which makes the iBOT, said the VA approved about 30 of the chairs in 2007.

Medicare and Medicaid, however, do not cover the iBOT.

Tom VanHook said Monday that whichever way Tricare decides to go, he hopes the agency will use the case to set a precedent so other families will not find themselves fighting years-long battles.

With legal fees in the case, VanHook said he figures Tricare "has spent far more money denying care than providing care."

Nancy Young, (757) 446-2947, nancy.young@pilotonline.com