Aug. 10--CRESTVIEW -- Seven-year-old Zachary Berge doesn't know his parents took on TRICARE on his behalf and won.
He can tell you what sound a duck makes and when he wants juice.
More complex communication skills are out of reach for Zachary, who was diagnosed with autism just after his 2nd birthday.
The couple was seeking coverage for Applied Behavior Analysis therapy, which was prescribed by Zachary's physician.
A federal judge ruled July 26 that TRICARE, the military's health insurance program, could not deny retired families benefits that it allows for active-duty families.
He called such a denial "arbitrary and capricious," said Dawn Berge, who with her husband Kenneth brought the suit against TRICARE on behalf of their son.
U.S. District Judge Reggie B. Walton in Washington, D.C., remanded the case "back to the agency with specific instructions that ABA therapy coverage be provided to Basic Program beneficiaries who otherwise qualify for reimbursement."
"It just didn't make sense to me being denied just because my husband was retired," Dawn Berge said.
The family lives in Crestview, but Zachary attends school at the Emerald Coast Autism Treatment Center in Niceville.
During the nearly two years the class-action lawsuit wound through the court system, the Berges paid out of their pocket and took out a second insurance policy to help pay for the therapy. They also received some assistance from a state-funded program for children with disabilities.
Dawn said that although they're happy the judge ruled in their favor, she and her husband have yet to notice any change in the way their claims are handled by TRICARE.
"We aren't sure yet," she said when asked how the judge's ruling might help them financially. "Right now, we're uncertain what's going to happen.
"Even though a judge has ruled that we won, we're still battling as far as getting coverage," she said. "Every time we call TRICARE and try to get some answers, they say, 'We don't know what you're talking about. We have to respect the policy as it's written and (ABA) isn't covered.' "
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