Re: Technology Evaluation Assessement

[Guest guest]

Dear ,

To my knowledge, there have been two TEC assessments. This first was

by Blue Cross Blue Shield in 1999/2000. It was brought to my

attention by a DOC Band parent, and I offered to participate, but

they politely refused my offer. The second (May 2001) was performed

by ECRI, a private research organization hired to review existing

medical literature and provide a summary to insurance companies. For

this one I was asked to be an outside reviewer, and I did find ECRI

to be objective and willing to listen.

What is important to recognize about these TEC evaluations is that

they are private reports, typically funded by insurance companies to

decided whether (and at what level) to cover existing medical

devices, drugs, etc. Often times, as with the case of BCBS' TEC,

they will pay for the initial study and then sell it to other

insurance providers. One mom in Florida asked her insurance company

for the TEC report and was told she could have one at a cost of $300.

I do have copies of these two reports, but am prohibited from giving

them out. But I can disclose that they recognize that cranial

banding is the standard of care for infants with plagiocephaly.

However since there are no studies comparing cranial banding against

untreated infants, insurance companies can still argue that the heads

would round out on their own. Additionally, the TEC evaluations also

noted a lack of evidence in the medical literature regarding long-

term functional problems associated with untreated plagiocpehaly.

In the end, the summaries were inconclusive. There were no denials

that the devices did successfully treat plagiocephaly, just that it

may not be necessary (head will round out on its own; if it doesn't,

there are no functional problems associated with it). While I

strongly disagree (we've seen many 2-5 year olds with plagiocephaly)

only time will provide the evidence the insurance companies are

looking for.

Tim Littlefield

R & D Director

Cranial Technologies, Inc.

> Hello.

>

> I am trying to find out ways to fight my appeal. On the medical

policy that was the basis of the invesgational reason, it lists a TEC

asessement as a reference. The only other reference was the

predecessor to the current policy. The assessment is titled " Cranial

Orthosis for Plagiocephaly Without Synostosis " . I am really wanting

to view this TEC assessment because I feel that it is the reason why

Dynamic Orthotic Cranioplasty was determined investigational by

Anthem BC/BS. Does anyone know about this assessment, or what it

says/found. I am in the process of filing a complaint with the state

insurance bureau but I want it to be a throuogh as possible.

>

> Thanks

> s