Re: Newbie introducing myself -- and questions about MA & Tufts insurance... (m)

[Guest guest]

Hi and Welcome to the group. Yes, very familiar story around these

parts.

First of all, insurance will be a pain. Many on this board are

fighting insurance. You need to find out from the insurance company

what they will and will not cover. This isn't the same as a regular

presciption. Unfortunately, many insurance policies have exclusions

depending on how the device is catergorized. Whether it's an

Orthotic or a nuerological device. Generally, the reason for denail

is the device is " not medically necessary " . They think it's

cosmetic.

Secondly, go with your gut. If you feel it is worth the correction,

go for it. Actually, can you get a second opinion or second

meaurements? It sucks that the orthist put those doubts in your

head. It's hard enough to deal with, even if you're 100% sure about

it. Is there a Cranial Technologies near you? I would say it might

be even worth a long drive to have them take a look and let you know

what they think. I believe they band up to 18 months. So ther might

be a stronger chance of correction with them. Regardless of getting

a band or a helmut, it would be a second opinion.

Hope that helps!

Ana & Jace (banded 4/5/02)

> Hello all!

>

> I am new here -- I have twin sons, 9.5 months old, and one of them

> has finally been diagnosed with plagio. It's a common story -- I

> started to notice flattening on the right side of his head in the

> early months, but my ped said " Oh no, it'll round out with time. "

> Repositioning didn't work, and of course he's now way beyond the

age

> when that would be effective. It doesn't seem to have gotten

worse

> lately, but it doesn't seem to have gotten better either. So at

the

> 9 month well baby visit, we decided to push for the specialist

> referral. We're in the Boston area, so we were referred to

> Craniofacial Center at Children's Hospital.

>

> had his appointment today -- the surgeon said that he

measured

> about a 12mm discrepancy (where 5-6 would be normal, 20 severe,

and

> they recommend a helmet for >10). They sent us directly down to

the

> orthotists for a casting.

>

> Since we'd made sure to get a referral to the specialist, and he

> recommended the helmet, I thought the insurance piece would be

> simple. However, the orthotist was talking about how our HMO

(Tufts)

> will routinely deny these claims and then you have to pay out of

> pocket & be reimbursed.

>

> Does anybody have any advice to share about this issue, especially

if

> it's local experience?? I guess I was figuring that it's like any

> other prescription -- and if we had the referral to the specialist

in

> the first place, surely it should all be covered. I was a bit put

> off, both by the orthotist's talk of insurance denial, and also

> because he started telling me what a mild case it is, and that he

> doesn't even think the helmet is necessarily required in such a

> case. He insisted on doing his own measurements (although he said

> they didn't count when it comes to the insurance issue -- what

> matters is what the doctor found). But *his* measurements were

only

> about a 9mm discrepancy, according to him. After having to push

so

> hard just to *get* to the referral and to have somebody

acknowledge

> that there *is* a problem, I felt really undermined by the

> orthotist's comments.

>

> Finally (sorry, I know this is long), this clinic only uses the

> helmets -- they don't use DOC bands at all. In addition, they

> usually cease treatment around 12 months of age. Given that my

son

> is older, does anybody have any advice about what is more likely

to

> be effective for him?? I was hoping that such a major facility as

> this would have the " best " treatment available, but I need to know

if

> there is a superior approach for older babies that they're not

> offering.

>

> Thanks so much -- I look forward to getting to know you!

>

> Giz. Mom to & Aidan.

[Guest guest]

HI, I too am from MASS ang going to Chidren's. Who have you been

seeing there? We see Dr. Mulliken and or Rusty in the NOPCO.

My son's name is also . He originally measured 17mm but is down

below 10mm after only 2 months of wearing the band. I wish I had some

help for you in regards to the insurance..I have Blue Cross and they

have covered everything....the nurse in Dr. Mulliken's office said

they cover anything that begins higher than 11mm. Good luck, hope to

talk to you more, since we are both in MA and going through the same

thing. I fortunately have had a great ped and was referred to

Children's to get the helmet when wsa just 4 months!! Hope to

talk to you soon.

Dianne

Marlborough, MA

> Hello all!

>

> I am new here -- I have twin sons, 9.5 months old, and one of them

> has finally been diagnosed with plagio. It's a common story -- I

> started to notice flattening on the right side of his head in the

> early months, but my ped said " Oh no, it'll round out with time. "

> Repositioning didn't work, and of course he's now way beyond the

age

> when that would be effective. It doesn't seem to have gotten worse

> lately, but it doesn't seem to have gotten better either. So at

the

> 9 month well baby visit, we decided to push for the specialist

> referral. We're in the Boston area, so we were referred to

> Craniofacial Center at Children's Hospital.

>

> had his appointment today -- the surgeon said that he measured

> about a 12mm discrepancy (where 5-6 would be normal, 20 severe, and

> they recommend a helmet for >10). They sent us directly down to

the

> orthotists for a casting.

>

> Since we'd made sure to get a referral to the specialist, and he

> recommended the helmet, I thought the insurance piece would be

> simple. However, the orthotist was talking about how our HMO

(Tufts)

> will routinely deny these claims and then you have to pay out of

> pocket & be reimbursed.

>

> Does anybody have any advice to share about this issue, especially

if

> it's local experience?? I guess I was figuring that it's like any

> other prescription -- and if we had the referral to the specialist

in

> the first place, surely it should all be covered. I was a bit put

> off, both by the orthotist's talk of insurance denial, and also

> because he started telling me what a mild case it is, and that he

> doesn't even think the helmet is necessarily required in such a

> case. He insisted on doing his own measurements (although he said

> they didn't count when it comes to the insurance issue -- what

> matters is what the doctor found). But *his* measurements were

only

> about a 9mm discrepancy, according to him. After having to push so

> hard just to *get* to the referral and to have somebody acknowledge

> that there *is* a problem, I felt really undermined by the

> orthotist's comments.

>

> Finally (sorry, I know this is long), this clinic only uses the

> helmets -- they don't use DOC bands at all. In addition, they

> usually cease treatment around 12 months of age. Given that my son

> is older, does anybody have any advice about what is more likely to

> be effective for him?? I was hoping that such a major facility as

> this would have the " best " treatment available, but I need to know

if

> there is a superior approach for older babies that they're not

> offering.

>

> Thanks so much -- I look forward to getting to know you!

>

> Giz. Mom to & Aidan.

[Guest guest]

Hi Giz & welcome to our group!

Do you know if the helmet your son will be receiving is a " passive "

style helmet? Passive helmets simply have a gap in the flat area of

the head that allows room for the flat side to fill in to the

helmet. Passive helmets simply rely on growth spurts, as the child's

head grows, it fills in the gap of the helmet.

" Active " bands or helmets such as the DOCband or STARband apply very

mild pressures to the non flat side of the child's head which

help " push " the the flat side out (sorry, this is MY non medical

definition!). Active bands do work better in " older " babies simply

becuz they are more active - passive bands work better on younger

infants becuz of how fast the infant's head is growing.

BUT, that does not mean your son won't get correction if the helmet

he will be getting is a passive design. We have members whose child

wore a local helmet " older " who still got correction.

It doesn't sound like you were any too impressed with the orthotist.

Does he have experience in treating plagio babies with their helmet?

The orthotist is the key to having success with these helmets.

How did your son handle the casting?

As for your insurance, that is one of the most common discussed

issues in our group. First find out why your ins. will deny the

helmet, then go from there. Many parents have had to appeal many

times before getting their helmet/band approved. Some unfortunately,

never got approvals. BUT, never give up!

Welcome again - please keep us updated.

Debbie Abby's mom DOCGrad

MI

-- In Plagiocephaly@y..., " gizgirl01 " <gizgirl@i...> wrote:

> Hello all!

>

> I am new here -- I have twin sons, 9.5 months old, and one of them

> has finally been diagnosed with plagio. It's a common story -- I

> started to notice flattening on the right side of his head in the

> early months, but my ped said " Oh no, it'll round out with time. "

> Repositioning didn't work, and of course he's now way beyond the

age

> when that would be effective. It doesn't seem to have gotten worse

> lately, but it doesn't seem to have gotten better either. So at

the

> 9 month well baby visit, we decided to push for the specialist

> referral. We're in the Boston area, so we were referred to

> Craniofacial Center at Children's Hospital.

>

> had his appointment today -- the surgeon said that he measured

> about a 12mm discrepancy (where 5-6 would be normal, 20 severe, and

> they recommend a helmet for >10). They sent us directly down to

the

> orthotists for a casting.

>

> Since we'd made sure to get a referral to the specialist, and he

> recommended the helmet, I thought the insurance piece would be

> simple. However, the orthotist was talking about how our HMO

(Tufts)

> will routinely deny these claims and then you have to pay out of

> pocket & be reimbursed.

>

> Does anybody have any advice to share about this issue, especially

if

> it's local experience?? I guess I was figuring that it's like any

> other prescription -- and if we had the referral to the specialist

in

> the first place, surely it should all be covered. I was a bit put

> off, both by the orthotist's talk of insurance denial, and also

> because he started telling me what a mild case it is, and that he

> doesn't even think the helmet is necessarily required in such a

> case. He insisted on doing his own measurements (although he said

> they didn't count when it comes to the insurance issue -- what

> matters is what the doctor found). But *his* measurements were

only

> about a 9mm discrepancy, according to him. After having to push so

> hard just to *get* to the referral and to have somebody acknowledge

> that there *is* a problem, I felt really undermined by the

> orthotist's comments.

>

> Finally (sorry, I know this is long), this clinic only uses the

> helmets -- they don't use DOC bands at all. In addition, they

> usually cease treatment around 12 months of age. Given that my son

> is older, does anybody have any advice about what is more likely to

> be effective for him?? I was hoping that such a major facility as

> this would have the " best " treatment available, but I need to know

if

> there is a superior approach for older babies that they're not

> offering.

>

> Thanks so much -- I look forward to getting to know you!

>

> Giz. Mom to & Aidan.

[Guest guest]

Thanks for the welcome Debbie!!

> Do you know if the helmet your son will be receiving is a " passive "

> style helmet?

Yes, unfortunately the helmet is a passive style. I spoke with the

surgeon, and he said that they only use the passive helmets. Before

I even got a referral from our pediatrician, I checked on the Cranial

Technologies website to see whether they have a clinic here in MA,

but the closest is CT.

> Active bands do work better in " older " babies simply

> becuz they are more active - passive bands work better on younger

> infants becuz of how fast the infant's head is growing.

I would prefer the DOC band, because the research I'd read also

seemed to indicate they were more effective in older children. But

the clinic at Children's Hospital here won't do them.

> It doesn't sound like you were any too impressed with the

orthotist.

> Does he have experience in treating plagio babies with their

helmet?

I guess the orthotist does have experience -- it's just that my son

is older than their average patient, so he seemed to spend a lot of

time telling me how mild his case was, and how he might try to take

the helmet off, and that my insurance won't cover it. After pushing

so hard to get my ped to give us a referral, & breathing a sigh of

relief/vindication when the surgeon *did* measure a treatable

discrepancy, I guess I just didn't want somebody else coming in &

telling me that it was barely worth treating!!

> How did your son handle the casting?

actually did great with the casting -- he seemed to enjoy the

process itself, which is pretty impressive since he was tired,

hungry, and the clinic had been running about three hours late!! He

screamed when it was removed though -- that was the nastiest bit.

Thanks again for the welcome, and also the encouragement. I'm

feeling a little overwhelmed by it all at the moment, but the support

really helps.

Giz.

Boston, MA

[Guest guest]

Hi Dianne!

> HI, I too am from MASS ang going to Chidren's. Who have you been

> seeing there? We see Dr. Mulliken and or Rusty in the NOPCO.

Thanks for the info -- yes, I'm going to Dr. Mulliken's clinic as

well. We actually ended up seeing a different doctor though, because

they were running so far behind yesterday (3 hours!!) that they

called somebody else in to help with the backlog.

> My son's name is also . He originally measured 17mm but is down

> below 10mm after only 2 months of wearing the band. I fortunately

have had a great ped and was referred to

> Children's to get the helmet when wsa just 4 months!!

I'm glad your son's treatment is going so well (and great choice of

name! *LOL*) You were lucky to have been able to pursue treatment so

early. I am kicking myself now for not taking a stand on this issue

sooner... Ah well, nothing I can do about that now.

> I wish I had some help for you in regards to the insurance..I have

> Blue Cross and they have covered everything....the nurse in Dr.

> Mulliken's office said they cover anything that begins higher than

> 11mm.

Thanks for that -- I don't know how that varies between insurance

companies, but hopefully it's roughly similar. I put a call in to

Dr. Mulliken's office this morning.

Thank you again for the support -- it's great to hear from somebody

who's local.

Giz.