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Re: Cigna - Sue Ellen

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Sue Ellen,

Thanks for this info, but something just occurred to me. The occipital region is the back, right? Both Sam and Sara had flat spots more on the side by their ears, and isn't that the temporal region of the brain? Or is it still considered occipital? It's been (I hate to admit this) 15 years since my college anatomy class, so feel free to correct me. How would that impact this argument?

Gail

Re: Re: Cigna denied us - AGAIN!

Hey ,

Thanks. We argued that DOC is a reconstructive procedure for a skull deformation, and this is what they responded with.

Though the appeal argues that treatment to correct an abnormal headshape is not cosmetic, a recent review of this subject in Pediatric Clinics of North America classifies occipital plagiocephaly as "simply a cosmetic problem", finds no evidence for secondary functional problems, and indicates that the goal of treatment is "improving cosmesis".

They didn't provide any info on this journal like issue, date, volume, author, or anything else. If you can find it I would be grateful.

Gail

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Gail:

Even though you are correct, the occipital region is located towards the back, plagiocephaly is said to effect the occipital region. If the flattening occurs more significanty in the temporal region (you are correct, the side!) and you would instead like to use this argument, then perhaps instead of getting an opthalmologist to write a letter for you, you could speak with a pediatric neurosurgeon. My opinion is that you should get both, as your insurance probably does cover neurology, as well. And to think, all of these medical bills could be avoided with THE APPROVAL OF A STINKIN' HELMET!!!!!!!!!!! (Sorry, struck a nerve!)

Pressure / damage to the temporal lobe of the brain can cause the following (and quite frankly, I must admit that I don't know what ALL of these conditions mean!!!!):

-speech automatisms

-receptive (Wernicke's) aphasia

-severe hypergraphia

-polymodal hullucinatory experience, recurrent

-paralysis

-profound mood changes, recurrent

-conscious confusion

-intense libidinal change

-salavitory episodes

-uncontrollable, lowly-precipitated, direct, non-amnesic, aggressive episodes

-blurred vision or diplopia

-lapses in consciousness

-seizures

-epilepsy & epileptic amnesia

Information found at: www.pni.org/neuropsychiatry/seizures/ptls.html

To review the different parts of the brain, check-out my attachment!

Hope this proves to be of help to you!

Re: Re: Cigna denied us - AGAIN!

Hey ,

Thanks. We argued that DOC is a reconstructive procedure for a skull deformation, and this is what they responded with.

Though the appeal argues that treatment to correct an abnormal headshape is not cosmetic, a recent review of this subject in Pediatric Clinics of North America classifies occipital plagiocephaly as "simply a cosmetic problem", finds no evidence for secondary functional problems, and indicates that the goal of treatment is "improving cosmesis".

They didn't provide any info on this journal like issue, date, volume, author, or anything else. If you can find it I would be grateful.

GailFor more plagio info

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