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The gym membership wasn’t that much - a couple hundred dollars a year, Ms. Kramer said. But the mileage was getting to be the expensive part - and could go on indefinitely if doctors continued to prescribe that treatment.

Assuming a reimbursement rate comparable to the federal 55 cents per mile that went into effect in October, if Mr. Lettery did a three-day-a-week regimen, the foundation’s insurance carrier would be on the hook for nearly $3,000 a year, for as long as his doctor recommended the treatment.

The appellate opinion issued earlier this month was unpublished, meaning the court does not intend for it to have any official precedential value. But Ms. Kramer said that it will now be more challenging for lawyers to argue similar cases.

“It would be a dead issue for most people,” she said. “Someone would have to figure out another angle to challenge this type of issue.”