Insurance Question and Update

[Guest guest]

I haven't posted here in a very long time but I had a quick question

and an update.

First, we finally got in for a consultation with Cranial Tech last

week, and much to my surprise, the person we saw said that Max has

a " severe deformity. " Now, I can tell quite clearly that his head is

misshappen and has a moderate level of asymetry, but I never thought

of him as severely deformed. If this is true, why did the pediatric

neurosurgeon say that it would correct itself in six months and that

we didn't need helmet therapy? I expected that from my general ped.

who doesn't know better (unfortunately), but how could the specialist

have been so wrong if he sees this type of thing all the time? Even

though we knew were going to move forward with DOC band therapy

before the consultation, it was very upsetting to be told my son has

a severe deformity and I can't help but wonder if the Cranial Tech

person was exaggerating a bit to " make the sale. " I know that sounds

horrible, and I'm usually not so cynical, but I'm completely confused

by all of the different stuff I'm being told.

Second, Cranial Tech showed us that Max's range of movement to one

side is severely limited. This didn't show up in the appointment

with the neuro. Is this what is known as torticollitis? We were

advised to start physical therapy for it.

Finally, our insurance company said that they would cover one half of

the total treatment amount (almost $4,000 where I live) if we could

prove the medical necessity. As someone in my husband's office went

through this last year without much hassle and got covered, I'm not

too worried about that. My question though is should we fight for

more, or based on what everyone else here has gone through does that

seem generous and should I leave it alone?

Sorry for all the questions. I'm just so confused right now. As it

is, Max will be 9 months old before he starts therapy and I'm kicking

myself for not pushing the doctors sooner. I've cried so much over

this and want to get past it. Thanks for the help and for listening.

Laurie

Mom to Eli (34 months) and Max (8 1/2 months)

[Guest guest]

My son started treatment with the DOCband at 9 and 1/2 months.

I've been thrilled with his progress so far so you are definitely not

starting too late. As far as differing opinions, I got a different

opinion from every specialist I went to; the neurosurgeon said it

would round out on its own, the craniofacial plastic surgeon said it

was mild/moderate and prescribed the band; the pediatrician said it

would pop out on its own; and Cranial Technologies labeled him a high

moderate. You have to go with your gut instincts on what is right

for your child which is obviously what you are doing. As far as

insurance, my policy covered 50 percent of his first band after

appealing and they also reduced it a little as it was out of network

so they covered about $1,300 of $3,000. You should check your policy

and see what the coverage is. I'm sure you will not regret putting

your son in a band at all. I am picking up my son's second band

today. Cranial Technologies in no way pushed him to get the second

band. They left the decision entirely up to me and the plastic

surgeon. He got about 60 percent correction (estimated) with the

first band and my feelings are even though he is 14 months he should

receive at least some correction with the second which is well worth

it.

Candy, mom to (DOCband #1, 10/5/01,#2 - 2/25/02)

land

> I haven't posted here in a very long time but I had a quick

question

> and an update.

>

> First, we finally got in for a consultation with Cranial Tech last

> week, and much to my surprise, the person we saw said that Max has

> a " severe deformity. " Now, I can tell quite clearly that his head

is

> misshappen and has a moderate level of asymetry, but I never

thought

> of him as severely deformed. If this is true, why did the

pediatric

> neurosurgeon say that it would correct itself in six months and

that

> we didn't need helmet therapy? I expected that from my general

ped.

> who doesn't know better (unfortunately), but how could the

specialist

> have been so wrong if he sees this type of thing all the time?

Even

> though we knew were going to move forward with DOC band therapy

> before the consultation, it was very upsetting to be told my son

has

> a severe deformity and I can't help but wonder if the Cranial Tech

> person was exaggerating a bit to " make the sale. " I know that

sounds

> horrible, and I'm usually not so cynical, but I'm completely

confused

> by all of the different stuff I'm being told.

>

> Second, Cranial Tech showed us that Max's range of movement to one

> side is severely limited. This didn't show up in the appointment

> with the neuro. Is this what is known as torticollitis? We were

> advised to start physical therapy for it.

>

> Finally, our insurance company said that they would cover one half

of

> the total treatment amount (almost $4,000 where I live) if we could

> prove the medical necessity. As someone in my husband's office

went

> through this last year without much hassle and got covered, I'm not

> too worried about that. My question though is should we fight for

> more, or based on what everyone else here has gone through does

that

> seem generous and should I leave it alone?

>

> Sorry for all the questions. I'm just so confused right now. As

it

> is, Max will be 9 months old before he starts therapy and I'm

kicking

> myself for not pushing the doctors sooner. I've cried so much over

> this and want to get past it. Thanks for the help and for

listening.

>

> Laurie

> Mom to Eli (34 months) and Max (8 1/2 months)

[Guest guest]

I expected that from my general ped.

> who doesn't know better (unfortunately), but how could the

specialist

> have been so wrong if he sees this type of thing all the time?

Even

> though we knew were going to move forward with DOC band therapy

> before the consultation, it was very upsetting to be told my son

has

> a severe deformity and I can't help but wonder if the Cranial Tech

> person was exaggerating a bit to " make the sale. " I know that

sounds

> horrible, and I'm usually not so cynical, but I'm completely

confused

> by all of the different stuff I'm being told.

Laurie:

In not only my own personal experience with Cranial Tech., but I've

heard so many times on this board, Cranial Tech is VERY honest about

babies with plagio.. I have heard of a few occasions where they

would NOT band a baby becuz their plagio was too mild. So, I would

say that Cranial Tech was not telling you this about Max's head

simply to make a sale.

I can't tell you why your ped. neuro and/or your ped. were telling

you it wasn't so bad & he wouldn't need helmet therapy. There are

still many Drs and ped. neuros out there who aren't educated well at

all on plagio and would rather used the " wait & see " approach.

>

> Second, Cranial Tech showed us that Max's range of movement to one

> side is severely limited. This didn't show up in the appointment

> with the neuro. Is this what is known as torticollitis? We were

> advised to start physical therapy for it.

That would be torticollis. Did your ped. ever mention this to you.

I remember when we brought Abby in for her DOCband they also

evaluated her quickly for tort.. Call your ped. and see if he will

refer you for phys. therapy.

>

> Finally, our insurance company said that they would cover one half

of

> the total treatment amount (almost $4,000 where I live) if we could

> prove the medical necessity. As someone in my husband's office

went

> through this last year without much hassle and got covered, I'm not

> too worried about that. My question though is should we fight for

> more, or based on what everyone else here has gone through does

that

> seem generous and should I leave it alone?

If they are covering 1/2, they're probabl;y covering it as Durable

Medical Equipment, which is what mine did. I don't know if fighting

for more would pay off for you, but you might try. It of course

depends on your policy.

>

> Sorry for all the questions. I'm just so confused right now. As

it

> is, Max will be 9 months old before he starts therapy and I'm

kicking

> myself for not pushing the doctors sooner. I've cried so much over

> this and want to get past it. Thanks for the help and for

listening.

9 mos is still plenty young enough to get good results from the

DOCband! Trust me! Please don't waste another tear over anything

you have done. You're doing a terrific job & it can be very

overwhelming to us parents at times.

Hang in there!!!!!!

Debbie Abby's mom DOCGrad 6/22/01

MI