A Navy Captain's Increasingly Absurd Fight Against Military Insurer to Pay For Disabled Daughter's Physical Therapy
When Kaitlyn Samuels was 4 months old, her parents, Mark and Jennifer, worried that she couldn't reach for her toys. Doctors initially assured them that it was probably normal, but after two months brought little improvement they ordered a battery of neurological tests that revealed Kaitlyn had a very rare and very serious brain malfunction.
Change.org The Samuels family, with Kaitlyn front and center
The years since then have been a struggle, as Kaitlyn has suffered the effects of epilepsy, cerebral palsy and all sorts of related complications. She can't speak or walk by herself. Her food has to be blended into liquid form because she can't chew. Her brain is frozen in perpetual toddlerhood.
Kaitlyn also suffers from severe scoliosis. Left unchecked, the condition would get progressively worse, with the increasing curvature of the spine diminishing lung capacity, popping joints out of socket and eventually killing her by crushing her internal organs. It can be treated with physical therapy, but traditional methods didn't work for Kaitlyn; she would grow bored and shut down, rendering the session worthless.
In 2009, the Samuels found a solution at Rocky Top Therapy Services in Keller, where the family was living. There, Kaitlyn is placed on a horse that is then led in a circle by volunteers and Suzanne Sessums, the family's physical therapist. The horse's breadth stretches Kaitlyn's legs while its movement works her hips and pelvis. All the while, she has to keep herself upright, strengthening her back and neck muscles. More important, Kaitlyn enjoyed being on the horse and stayed engaged for the duration of the twice-weekly, 30-minute sessions.
Mark Samuels is a captain in the Navy, and the treatments were paid for through TRICARE, the health plan for Department of Defense employees -- at least they were for nearly a year, until TRICARE abruptly decided the treatments count as hippotherapy and would not be covered under the Samuels' health plan.
What's ensued for the Samuels has been a two-year battle against a Kafkaesque bureaucracy. When it determined Kaitlyn's therapy wasn't covered, TRICARE decided the Samuels should repay the insurer $1,300 for several month's of treatment they hadn't previously objected to. The Samuels filed an appeal, claiming their daughter was simply receiving physical therapy that happened to be on a horse, and that the treatments should be covered.
The appeal wound its way through the byzantine Department of Defense appeals process -- at one point in the fall of 2011, hearings were delayed for two months because Congress had not passed a federal budget -- before the family wound up in a Dallas courtroom to argue their case.