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

[Guest guest]

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.