Re: Insurance Issue Question?

[Guest guest]

Hi Shimi:

Welcome to our group! I'm not too familiar with Aetna's coverage of

bands in the past. You can search our group archive by typing

in " Aetna " in that area, then scroll thru (keep clickning next) as it

will go thru each month & will show any posts that included the word

Aetna.

What type of helmet or band will the twins be receiving?

I am not familiar with the instrument you have descrived for

measurements....hmm, it sounds interesting though. If you get any

more info on it, please let us know.

Would you mind giving us a little more information on your twins &

their plagio? We'd love to hear more!

Welcome again to our group! We're glad you found us.

Debbie Abby's mom DOCgrad

MI

> Hi everyone,

>

> I want to first of all say what a great resource you guys are!!!!

My name is Shimi and I have twin boys and .

>

> They were diagnosed with Plagio at 3 months and they are now a

little over 6 months. I'm going through a battle with my insurance

AEetna US Healthcare of Pennsylvania. I was wondering if anyone has

gotten AEtna to cover a helment/band. Currently, the insurance

company is asking for measurements with an instrument that our

pediatric neurosurgeon at St. does not own and he does

not know of anyone that has this instrument either. Any info anyone

has would be great. My husband and I are ready to fork up the

payment on our own b/c we can't wait any longer.

>

> Thank you in advance.

>

> Shimi

> and (6 months)

[Guest guest]

Hi Shimi and boys, and welcome to the group! I am also the proud

parent of twins, Kaylie & Danny, and our neuro was at St.

's as well! Do you mind if I ask who it is you are

seeing? We saw Dr. Neff, and the only measurements he ever

took was with a tape measure.

I don't have any personal experience with AEtna US Healthcare, but

from what I can recall from this group, they usually will provide

coverage *IF* the assymetrical measurements fall within their

guidelines. Perhaps that is why they are asking for a different type

of instrument, maybe to take more accurate measurements? I really

have no idea!

Anyway, I wanted to wish you , and luck! And again,

welcome to the group!

Niki

Kaylie & Danny (STAR grads)

Phila., PA

> Hi everyone,

>

> I want to first of all say what a great resource you guys are!!!!

My name is Shimi and I have twin boys and .

>

> They were diagnosed with Plagio at 3 months and they are now a

little over 6 months. I'm going through a battle with my insurance

AEetna US Healthcare of Pennsylvania. I was wondering if anyone has

gotten AEtna to cover a helment/band. Currently, the insurance

company is asking for measurements with an instrument that our

pediatric neurosurgeon at St. does not own and he does

not know of anyone that has this instrument either. Any info anyone

has would be great. My husband and I are ready to fork up the

payment on our own b/c we can't wait any longer.

>

> Thank you in advance.

>

> Shimi

> and (6 months)

[Guest guest]

Hi Debbie,

Thanks for the welcome and response.

We have an appointment to see an orthotist at Harry J. Lawall on Monday. 's favors looking to the left so his head is extremely flat especially behind his left ear (positional). He is starting to bulge unevenly at the sides but his ears still appear to be aligned. In 's case, he is flat in the back of his head (brach) and he is also bulging at the sides. We are looking at getting a starband for them. is definitely not as severe as 's. I am torn about getting a band for but I don't want him to grow up and ask why 's head is so much rounder than his.

The waiting is keeping me up at nights. I wake up 4 - 5 times a night to turn their heads so it doesn't get any worse. Each day that goes by, their heads are getting worse. I'm ready to throw my hands up and just pay for it out of pocket. My husband just spoke with Aetna and they are giving us the run around again. I guess I am just so frustrated which I am sure everyone is.

Thanks for letting me vent.

Shimi

and (6 months)

Re: Insurance Issue Question?

Hi Shimi:Welcome to our group! I'm not too familiar with Aetna's coverage of bands in the past. You can search our group archive by typing in "Aetna" in that area, then scroll thru (keep clickning next) as it will go thru each month & will show any posts that included the word Aetna.What type of helmet or band will the twins be receiving? I am not familiar with the instrument you have descrived for measurements....hmm, it sounds interesting though. If you get any more info on it, please let us know.Would you mind giving us a little more information on your twins & their plagio? We'd love to hear more!Welcome again to our group! We're glad you found us.Debbie Abby's mom DOCgradMI> Hi everyone,> > I want to first of all say what a great resource you guys are!!!! My name is Shimi and I have twin boys and .> > They were diagnosed with Plagio at 3 months and they are now a little over 6 months. I'm going through a battle with my insurance AEetna US Healthcare of Pennsylvania. I was wondering if anyone has gotten AEtna to cover a helment/band. Currently, the insurance company is asking for measurements with an instrument that our pediatric neurosurgeon at St. does not own and he does not know of anyone that has this instrument either. Any info anyone has would be great. My husband and I are ready to fork up the payment on our own b/c we can't wait any longer.> > Thank you in advance.> > Shimi> and (6 months)For more plagio info

[Guest guest]

Hi Niki!

Our doctor at St. was Dr. Piatt. He recommended that we goto Harry J. Lawall for a STAR band and we have an appointment on Monday to see them. I spoke to one of the practitioner and he told me that they will be doing measurements for us. We'll see how it goes.

Would you mind me asking where you went for the STARband? and was it covered by your insurance?

I am currently torn about getting both boys a band. is much more severe than but I don't want to grow up asking why his head is flatter than . As a mother of twins did you have this dilemma?

Thanks!!!

Shimi

and (6 months)

Re: Insurance Issue Question?

Hi Shimi and boys, and welcome to the group! I am also the proud parent of twins, Kaylie & Danny, and our neuro was at St. 's as well! Do you mind if I ask who it is you are seeing? We saw Dr. Neff, and the only measurements he ever took was with a tape measure. I don't have any personal experience with AEtna US Healthcare, but from what I can recall from this group, they usually will provide coverage *IF* the assymetrical measurements fall within their guidelines. Perhaps that is why they are asking for a different type of instrument, maybe to take more accurate measurements? I really have no idea!Anyway, I wanted to wish you , and luck! And again, welcome to the group!NikiKaylie & Danny (STAR grads)Phila., PA> Hi everyone,> > I want to first of all say what a great resource you guys are!!!! My name is Shimi and I have twin boys and .> > They were diagnosed with Plagio at 3 months and they are now a little over 6 months. I'm going through a battle with my insurance AEetna US Healthcare of Pennsylvania. I was wondering if anyone has gotten AEtna to cover a helment/band. Currently, the insurance company is asking for measurements with an instrument that our pediatric neurosurgeon at St. does not own and he does not know of anyone that has this instrument either. Any info anyone has would be great. My husband and I are ready to fork up the payment on our own b/c we can't wait any longer.> > Thank you in advance.> > Shimi> and (6 months)For more plagio info

[Guest guest]

Shimi,

I just have to say that your babies are beautiful! So precious!

Thanks for sharing!

Marci (mom to )

Oklahoma

[Guest guest]

What kind of polan is BCBS Personal choice? We have Anthem BCBS are

we rejected because they stated it was eperimental or

Investigational.

In Plagiocephaly@y..., " niki_jay175 " <niki_jay175@y...> wrote:

> What a small world Shimi!!!! We got our bands at Harry J. Lawall

> too! We went to their ford Avenue location, is this where you

> are going? Do you have any idea who it was that you spoke with?

My

> ortho was Bud Lawall, and I cannot say enough wonderful things

about

> him!! If you are going with Bud, you will be in really good

hands.

> He has about 20 years of plagio experience under his belt!

>

> Our insurance, BCBS Personal Choice, did cover the bands, as long

as

> we had a letter of medical necessity. We got that letter with no

> problem from St. 's.

>

> It's so nice to see someone from the area here! Do you live in

> Philadelphia as well?

>

> Take care Shimi, and keep us posted!

>

> Niki

> Kaylie & Danny (STAR grads)

> Phila., PA

>

>

> > > Hi everyone,

> > >

> > > I want to first of all say what a great resource you guys

> are!!!!

> > My name is Shimi and I have twin boys and .

> > >

> > > They were diagnosed with Plagio at 3 months and they are now

a

> > little over 6 months. I'm going through a battle with my

> insurance

> > AEetna US Healthcare of Pennsylvania. I was wondering if

anyone

> has

> > gotten AEtna to cover a helment/band. Currently, the insurance

> > company is asking for measurements with an instrument that our

> > pediatric neurosurgeon at St. does not own and he

> does

> > not know of anyone that has this instrument either. Any info

> anyone

> > has would be great. My husband and I are ready to fork up the

> > payment on our own b/c we can't wait any longer.

> > >

> > > Thank you in advance.

> > >

> > > Shimi

> > > and (6 months)

> >

> >

> >

[Guest guest]

Pardon me for butting in on this, but I had to share that we were torn with whether or not to band both of our twins or just one. We knew that we would band Sara no matter what, but we weren't sure about Sam. We didn't think he was as severe. We were talking with some very good friends who told us that if we didn't band Sam as well that they would write us a check for $3000 to cover it so that money wouldn't be an issue. If was good to have their persepective, and in the end we decided to band them both (we were able to pay by ourselves and didn't need their money). Later we found out that Sam was actually MORE severe than Sara and we would have made a big mistake in choosing not to band him. Looking back, I'm so glad that we didn't leave it up to chance. They both look so much better and we have no regrets. Now if we can just get Cigna to pay...

Gail, Sam and Sara's mom, DOC grads

Re: Insurance Issue Question?

Hi Shimi and boys, and welcome to the group! I am also the proud parent of twins, Kaylie & Danny, and our neuro was at St. 's as well! Do you mind if I ask who it is you are seeing? We saw Dr. Neff, and the only measurements he ever took was with a tape measure. I don't have any personal experience with AEtna US Healthcare, but from what I can recall from this group, they usually will provide coverage *IF* the assymetrical measurements fall within their guidelines. Perhaps that is why they are asking for a different type of instrument, maybe to take more accurate measurements? I really have no idea!Anyway, I wanted to wish you , and luck! And again, welcome to the group!NikiKaylie & Danny (STAR grads)Phila., PA> Hi everyone,> > I want to first of all say what a great resource you guys are!!!! My name is Shimi and I have twin boys and .> > They were diagnosed with Plagio at 3 months and they are now a little over 6 months. I'm going through a battle with my insurance AEetna US Healthcare of Pennsylvania. I was wondering if anyone has gotten AEtna to cover a helment/band. Currently, the insurance company is asking for measurements with an instrument that our pediatric neurosurgeon at St. does not own and he does not know of anyone that has this instrument either. Any info anyone has would be great. My husband and I are ready to fork up the payment on our own b/c we can't wait any longer.> > Thank you in advance.> > Shimi> and (6 months)For more plagio info

[Guest guest]

Gail,

Thank you so much for your perspective on twins. You just made my decision for me. I am going to go ahead with both. THANK YOU!!!

Shimi

and (6 months)

Re: Insurance Issue Question?

Hi Shimi and boys, and welcome to the group! I am also the proud parent of twins, Kaylie & Danny, and our neuro was at St. 's as well! Do you mind if I ask who it is you are seeing? We saw Dr. Neff, and the only measurements he ever took was with a tape measure. I don't have any personal experience with AEtna US Healthcare, but from what I can recall from this group, they usually will provide coverage *IF* the assymetrical measurements fall within their guidelines. Perhaps that is why they are asking for a different type of instrument, maybe to take more accurate measurements? I really have no idea!Anyway, I wanted to wish you , and luck! And again, welcome to the group!NikiKaylie & Danny (STAR grads)Phila., PA> Hi everyone,> > I want to first of all say what a great resource you guys are!!!! My name is Shimi and I have twin boys and .> > They were diagnosed with Plagio at 3 months and they are now a little over 6 months. I'm going through a battle with my insurance AEetna US Healthcare of Pennsylvania. I was wondering if anyone has gotten AEtna to cover a helment/band. Currently, the insurance company is asking for measurements with an instrument that our pediatric neurosurgeon at St. does not own and he does not know of anyone that has this instrument either. Any info anyone has would be great. My husband and I are ready to fork up the payment on our own b/c we can't wait any longer.> > Thank you in advance.> > Shimi> and (6 months)For more plagio info

[Guest guest]

Niki,

Thank you for your response to my questions. It is really comforting to know that I am making the right decision by having them both banded. You are right on the nose, when you said it would be one less thing they could blame you for when they are teenagers.

I am extremely nervous about the casting but I have to remember your words, "all will be forgotten and forgiven in no time."

Thanks so much!!

Shimi

and (6 months)

Re: Insurance Issue Question?

Shimi, Your boys are absolutely the cutest!! They really are so cute!I am so sorry, I totally forgot to address your question about getting both twins banded. I'll try to be brief with my answer! My daughter Kaylie had mild plagio, and my neuro really felt that she didn't need to be banded because he thought it would round out on its own (ARGH!) Danny had mild to moderate brachycephaly, and the neuro felt that if I was going to get either one of them banded, it would be Danny. My husband and I talked many nights over this, and in the end it came down to me being able to look at Kaylie sometime down the road and know that I did everything I could for her. I didn't want her coming to me when she was 15 asking why her head looked crooked, or why her one eye and cheek were big. I could just piture myself saying, "Well Kaylie, we decided to take a gamble with your headshape and wait to see if it rounded out on its own. But doesn't Danny's head look wonderful? We didn't want to take a chance with his." That pretty much sealed the deal for me! And I am really am happy that I had Kaylie banded as well. Who knows if it would have rounded out on its own, I really don't care. All I know is this is one less thing either one of them can blame me for when they are teenagers!The casting is very similar to the DOCband. The only major difference was, we weren't offered a wash room or anything to clean the twins up. But do expect the little stocking cap being put over their heads, and then the strips of plaster of paris. If your twins are anything like mine, they will scream the whole time. Just remember that it isn't hurting them, but instead they are angry and most likely frightened. But all will be forgot and forgiven in no time!NikiKaylie & Danny (STAR grads)Phila., PA> It sure is a small world!! I actually live in the suburb of Philly (Doylestown) and we are going to the Willow Grove office for the band. I hate to say that I do not know whom I spoke with on the phone but I'll find out on Monday who we will be working with. Wow....I am so happy that your band was covered. Dr. Piatt said that Aetna wanted more than the letter. They wanted precise measurements with an instrument he did not have. It frustrates me that they (Insurance) would think that we want to put our babies in these bands just b/c we felt like it.> > Anyway, we'll see what happens on Monday. My husband and I are making a realization that we will be paying for these bands. Our twins are worth every penny. > > Here's a pic of them. I am sure I'll put pics of them with their bands once they are in them.> > Is the casting similar to the DOC band?> > Shimi> and (6 months)For more plagio info

[Guest guest]

In a message dated 7/17/2002 12:07:09 PM Eastern Daylight Time, csdaly@... writes:

We have an appointment to see an orthotist at Harry J. Lawall on Monday. 's favors looking to the left so his head is extremely flat especially behind his left ear (positional). He is starting to bulge unevenly at the sides but his ears still appear to be aligned. In 's case, he is flat in the back of his head (brach) and he is also bulging at the sides

Hi Shimi,

Just wondering if you have had checked for torticollis? It could be that he cannot turn to the right physically, and may need pt to stretch out his muscle so that he can fully rotate to the left. Try to make him look to the right with toys, tv, dogs, whatever, and if you feel this may be a concern, email me and I can share more on that. Good luck on fighting aetna- sad to say that I think some members have had to pay out of pocket to get things moving, I hope they can share with you if they were reimbursed or denied, etc. because of paying out of pocket. Good luck and all the best to getting things moving in the right direction. Try to keep repositioning as hard as it is, every little bit helps! Keep us updated on your progress!

' Mom

[Guest guest]

Shimi,

Now those are some big boys!! LOL! They look to be identical from what i

could bring into frame- are they? So cute!!

' Mom

[Guest guest]

Gail,

Great post! Thanks for sharing your insight and its really baffling to think

that Sam ended up being more severe after all!

' mom

[Guest guest]

In a message dated 7/24/2002 10:50:05 AM Eastern Daylight Time, rella1234@... writes:

and may need pt to stretch out his muscle so that he can fully rotate to the left.

oops- I meant right!!!! Right!

[Guest guest]

In a message dated 7/24/2002 12:04:57 PM Eastern Daylight Time, csdaly@... writes:

We actually had checked out for Tort and the neurosurgeon said he didn't have it. He has no problems turning his head either direction, they just thought he favored the left

Shimi,

Great to hear that its just a preference thing going on. And, yeah, they sure do look similar in some ways- 18lbs!!!! was only 25 at his year check up! He's a string bean like Dad!

' Mom

[Guest guest]

,

Thanks!! Yep....I guess it could be the breastmilk. It's so funny how I see them everyday and they don't seem so big to me but when other 6 month olds are next to them....they look big. At their 6 mo. well-check, they were both around 18 lbs. Yikes!!! Anyway....they are actually fraternal but they do look identical in many ways.

Shimi

and (STARband soon....)

Re: Re: Insurance Issue Question?

Shimi,Now those are some big boys!! LOL! They look to be identical from what i could bring into frame- are they? So cute!!' MomFor more plagio info

[Guest guest]

Hi ,

We actually had checked out for Tort and the neurosurgeon said he didn't have it. He has no problems turning his head either direction, they just thought he favored the left. I am going to keep an eye on it. Thanks for the advice.

Shimi

and (STARband soon...)

Re: Re: Insurance Issue Question?

In a message dated 7/17/2002 12:07:09 PM Eastern Daylight Time, csdaly@... writes:

We have an appointment to see an orthotist at Harry J. Lawall on Monday. 's favors looking to the left so his head is extremely flat especially behind his left ear (positional). He is starting to bulge unevenly at the sides but his ears still appear to be aligned. In 's case, he is flat in the back of his head (brach) and he is also bulging at the sidesHi Shimi,Just wondering if you have had checked for torticollis? It could be that he cannot turn to the right physically, and may need pt to stretch out his muscle so that he can fully rotate to the left. Try to make him look to the right with toys, tv, dogs, whatever, and if you feel this may be a concern, email me and I can share more on that. Good luck on fighting aetna- sad to say that I think some members have had to pay out of pocket to get things moving, I hope they can share with you if they were reimbursed or denied, etc. because of paying out of pocket. Good luck and all the best to getting things moving in the right direction. Try to keep repositioning as hard as it is, every little bit helps! Keep us updated on your progress!' MomFor more plagio info