Guest guest Posted April 12, 2004 Report Share Posted April 12, 2004 Where are you in SC? I am in Simpsonville. I have Cigna PPO so I am no help on insurance. Where are you going for treatment? and Jack 12/9/04 twin ASTARband due in April 19Greenville, SC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2004 Report Share Posted May 12, 2004 You can try, but be happy. 20% is not that bad. If the insurance policy states 20% for orthotics, then you will probably end up paying it. Best wishes! --- In Plagiocephaly , " aboysmom " <deblonde1@a...> wrote: > I called my insurance company prior to getting the Cranio Cap to find > out the coverage. I was told they pay 80% and I have to pay 20%. Is > that something I can try to fight to get them to pay all of it or > should I be happy they will at least pay that much? (I have > HealthPartners) Thanks in advance! > > in Minnesota ~ Ty 9 mos ~ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2004 Report Share Posted May 12, 2004 I think it would depend on your coverages. Our insurance covers under durable medical equipment and it only covers 80%, no matter what type it is. Connor (PPO helmet 5/4/04) St. Louis, Mo. > I called my insurance company prior to getting the Cranio Cap to find > out the coverage. I was told they pay 80% and I have to pay 20%. Is > that something I can try to fight to get them to pay all of it or > should I be happy they will at least pay that much? (I have > HealthPartners) Thanks in advance! > > in Minnesota ~ Ty 9 mos ~ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2004 Report Share Posted October 12, 2004 Hi ! I'm so sorry to hear that you may be having trouble with insurance. It's infuriating! In the column to the left of your screen, click " Files " , then " Insurance Help " for sample letters sent for appeals and also documents and articles sent along with the letters (AMA Resolution 119, etc.) to ins. co.'s. If you have any further questions, please let us know. Good luck! Sue Colin F., 1 yr old. brachy, STARband grad 9/15/04 > > hi, > does anyone who has had their insurance agree to pay have any tips > for me on what would be good to send to my insurance co so that they > will maybe even help pay for part of it. we have triwest insurance. > thanks alot > angela/ el cajon ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2004 Report Share Posted October 12, 2004 , I see you have Triwest insurance. Is that through the military? If it is, is it prime, standard, or prime remote. I don't think which type you have makes much of a difference, but I know that with standard you pay more out of pocket if they don't deny your claim. Make sure you have a letter of medical necessity, script for the band, if you have been repositioning send documentation (hopefully from the doctor) that repo isn't working. We are military and my older daughter who is now 5 went through DOC band therapy 4 years ago. We were denied and ended up appealing so be ready for that as well. We never did win, but there are a few reasons for that. I was young, didn't know what I was doing very well, I don't think I sent an appeal letter that was worth anything cause I didn't know how to write one, and the step I made it to they wanted me to go to CO from NC for a hearing. At that time my ex-husband and I couldn't afford a trip like that (not that he was much help anyway). Now if with my second daughter, if repo doesn't work and she has to go through band therapy and we are denied by triwest my husband and I will be able to go to CO as we live in KS and it is much easier to get there and we are better off financially. I also know more about how to write an appeal letter etc. Johanna and repo'in lyse >From: "angelahaiden1" <angelahaiden@...> >Reply-Plagiocephaly >Plagiocephaly >Subject: insurance question >Date: Tue, 12 Oct 2004 06:33:28 -0000 > Rock, jazz, country, soul more. Find the music you love on MSN Music! hi, does anyone who has had their insurance agree to pay have any tips for me on what would be good to send to my insurance co so that they will maybe even help pay for part of it. we have triwest insurance. thanks alot angela/ el cajon ca For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2004 Report Share Posted October 12, 2004 Hi , Have you already been ofically denied? On what grounds? , mom to Hannah, DOCgrad Cape Cod, Ma > > hi, > does anyone who has had their insurance agree to pay have any tips > for me on what would be good to send to my insurance co so that they > will maybe even help pay for part of it. we have triwest insurance. > thanks alot > angela/ el cajon ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2004 Report Share Posted October 12, 2004 hi sarah, no not yet, but its been made perfectly clear that it will be. angela/ el cajon ca-- In Plagiocephaly , " " <sarahhollis@y...> wrote: > > Hi , > Have you already been ofically denied? On what grounds? > , mom to Hannah, DOCgrad > Cape Cod, Ma > > > > > > hi, > > does anyone who has had their insurance agree to pay have any tips > > for me on what would be good to send to my insurance co so that > they > > will maybe even help pay for part of it. we have triwest > insurance. > > thanks alot > > angela/ el cajon ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2004 Report Share Posted October 19, 2004 I can't remember who has dealt with this problem, but here is a link to the CAPPSkids website which includes a sample appeal letter for orthotic exclusions: http://www.cappskids.org/PlagioInsuranceHelp.htm Sorry I can't be of more help. (Connor - PPO helmet grad 8/04, tort) > > Hi everyone. Thank you for the insurance code for the DOC Band. Now > I have called my insurance company and they said that my policy does > not cover orthotics. I was wondering if it was this way with most > policies and if you show necessity if they will cover the band. I > don't know yet if we will have to get a band for ...but I want > to be prepared. Has anyone ever gotten payment when their policy > says that it does not cover orthotics. > Thank you very much!!!! > SAM-Mom to Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 16, 2005 Report Share Posted January 16, 2005 Hi Amy, Here is a past message from Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2005 Report Share Posted January 17, 2005 Amy- I too an faced with the same issue, except my insurance will only cover 15 visits. I was told by someone that Apraxia is covered by the ADA and that I should be able to get someone - even to come to my house - through that bill. I have been trying to research that option, but as yet I have no answer. Is there anyone out there who has tried this or who knows about this? Kim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2005 Report Share Posted January 17, 2005 Here is a link with all sorts of GREAT insurance info for apraxia!!!! Bookmark this one! http://www.speechville.com/diagnosis-destinations/apraxia/insurance.html Tricia Morin North Carolina Kim wrote: Amy- I too an faced with the same issue, except my insurance will only cover 15 visits. I was told by someone that Apraxia is covered by the ADA and that I should be able to get someone - even to come to my house - through that bill. I have been trying to research that option, but as yet I have no answer. Is there anyone out there who has tried this or who knows about this? Kim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2005 Report Share Posted May 31, 2005 It somewhat depends on who participates with your Insurance. I don't know that it always makes a difference. Oh, and there aren't really " generic " bands (not like how you think of " generic " prescriptions), they are different BRANDS of bands. You can always call your Insurance Company and ask if they would cover a DOC, or a Hanger Band or a STARband etc. Jen --- In Plagiocephaly , " pateltoral " <pateltoral@y...> wrote: > > In terms of getting insurance to cover the helmet - does it make it > any harder if you get a DOC (cranial tech) band as opposed to other > generic bands? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2005 Report Share Posted May 31, 2005 It depends on your insurance company. Check your policy or give them a call. CAROLG --- In Plagiocephaly , " pateltoral " <pateltoral@y...> wrote: > > In terms of getting insurance to cover the helmet - does it make it > any harder if you get a DOC (cranial tech) band as opposed to other > generic bands? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2005 Report Share Posted July 15, 2005 Jen, I don't know if this will help, but here are some links I pulled together from different folders in the links section (if the link is more than one line long, you'll need to copy and paste the entire link to your address bar to get directed correctly): DOCband is FDA approved for use on infants 3 - 18 months of age. http://www.fda.gov/cdrh/pdf/k964992.pdf AAP Release July 2003 Prevention & Management of Positional Skull Deformities in Infants - AAP finally acknowledges relationship of " back to sleep " in increase in plagio! Excerpt: " " The best response for helmets occurs in the age range of 4 to 12 months because of the greater malleability of the young infant skull bone and the normalizing effect of the rapid growth of the brain. There is less modification of the cranial configuration when used after 12 months of age. " http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/1/ 199?fulltext=plagiocephaly & searchid=QID_NOT_SET Treatment of the " older " infant with plagiocephaly This study documents that even though early intervention is best, treatment can still be successful even if the child is older than 12 months of age. Excerpt: " " Through a series of case reports, they present evidence that this treatment remains viable during the 2nd year of life and that improvement has been observed in infants in whom treatment has been initiated as late as 18 months. " http://www.aans.org/education/journal/neurosurgical/sep00/9-3-5.pdf Healthlink Medical Policy: CRANIAL ORTHOSIS FOR NON-SYNOSTOTIC PLAGIOCEPHALY Cranial orthosis is considered INVESTIGATIONAL/NOT MEDICALLY NECESSARY as a treatment of nonsynostotic plagiocephaly as a technique to prevent or modify potential associated functional impairments. Cranial orthosis as a treatment of nonsynostotic plagiocephaly may be considered eligible for coverage as a reconstructive procedure/technique* in patients who meet the following criteria. *The specific contract language regarding the scope of reconstructive benefits must be reviewed to determine coverage eligibility. For example, some, but not all contracts may consider repair of congenital abnormalities as a coverage-eligible reconstructive service. Coverage eligibility of acquired nonsynostotic plagiocephaly, as a result of post natal positioning, may also be subject to contractual definition of reconstructive services. State mandates may also apply. Cranial orthoses are ineffective and NOT MEDICALLY NECESSARY in children aged 18 months and over. Excerpt: " " For children greater than 6 months of age but less than 18 months " http://www.healthlink.com/provider/medpolicy/policies/durable/external_ molding.html Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study (This study supports natural correction. it does show however, that natural correction occurred from 12 months old to 24 months old in the group of infants studied, so one could infer that bands ought to work even better.) Excerpt: " Prevalence of either plagiocephaly or brachycephaly or both increased between 6 weeks and 4 months, decreased to one third of the 4-month level by 1 year, and then halved again by 2 years. " http://www.findarticles.com/p/articles/mi_m0950/is_4_114/ai_n6256703 If I find anything else that may help, even if it's a stretch, I'll post. Good luck with your appeal, Christie (Mom to Repo'd Remy) > hi everyone - we were just denied coverage for our 2nd doc band and > their reason was that there is no real proof that after 12 months old > and 4 months in one band - a second one was not going to do much. does > anyone have any resources i can use for our second appeal? any > literature i can use to back up my opinion that it will work (even if > it doesn't - it is worth trying!!!!) > thank you!! > jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2005 Report Share Posted July 15, 2005 Jen, I don't know if this will help, but here are some links I pulled together from different folders in the links section (if the link is more than one line long, you'll need to copy and paste the entire link to your address bar to get directed correctly): DOCband is FDA approved for use on infants 3 - 18 months of age. http://www.fda.gov/cdrh/pdf/k964992.pdf AAP Release July 2003 Prevention & Management of Positional Skull Deformities in Infants - AAP finally acknowledges relationship of " back to sleep " in increase in plagio! Excerpt: " " The best response for helmets occurs in the age range of 4 to 12 months because of the greater malleability of the young infant skull bone and the normalizing effect of the rapid growth of the brain. There is less modification of the cranial configuration when used after 12 months of age. " http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/1/ 199?fulltext=plagiocephaly & searchid=QID_NOT_SET Treatment of the " older " infant with plagiocephaly This study documents that even though early intervention is best, treatment can still be successful even if the child is older than 12 months of age. Excerpt: " " Through a series of case reports, they present evidence that this treatment remains viable during the 2nd year of life and that improvement has been observed in infants in whom treatment has been initiated as late as 18 months. " http://www.aans.org/education/journal/neurosurgical/sep00/9-3-5.pdf Healthlink Medical Policy: CRANIAL ORTHOSIS FOR NON-SYNOSTOTIC PLAGIOCEPHALY Cranial orthosis is considered INVESTIGATIONAL/NOT MEDICALLY NECESSARY as a treatment of nonsynostotic plagiocephaly as a technique to prevent or modify potential associated functional impairments. Cranial orthosis as a treatment of nonsynostotic plagiocephaly may be considered eligible for coverage as a reconstructive procedure/technique* in patients who meet the following criteria. *The specific contract language regarding the scope of reconstructive benefits must be reviewed to determine coverage eligibility. For example, some, but not all contracts may consider repair of congenital abnormalities as a coverage-eligible reconstructive service. Coverage eligibility of acquired nonsynostotic plagiocephaly, as a result of post natal positioning, may also be subject to contractual definition of reconstructive services. State mandates may also apply. Cranial orthoses are ineffective and NOT MEDICALLY NECESSARY in children aged 18 months and over. Excerpt: " " For children greater than 6 months of age but less than 18 months " http://www.healthlink.com/provider/medpolicy/policies/durable/external_ molding.html Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study (This study supports natural correction. it does show however, that natural correction occurred from 12 months old to 24 months old in the group of infants studied, so one could infer that bands ought to work even better.) Excerpt: " Prevalence of either plagiocephaly or brachycephaly or both increased between 6 weeks and 4 months, decreased to one third of the 4-month level by 1 year, and then halved again by 2 years. " http://www.findarticles.com/p/articles/mi_m0950/is_4_114/ai_n6256703 If I find anything else that may help, even if it's a stretch, I'll post. Good luck with your appeal, Christie (Mom to Repo'd Remy) > hi everyone - we were just denied coverage for our 2nd doc band and > their reason was that there is no real proof that after 12 months old > and 4 months in one band - a second one was not going to do much. does > anyone have any resources i can use for our second appeal? any > literature i can use to back up my opinion that it will work (even if > it doesn't - it is worth trying!!!!) > thank you!! > jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2005 Report Share Posted July 16, 2005 WOW!! I think I will use some of those links! --- In Plagiocephaly , " redlocks2003 " <redlocks@b...> wrote: > Jen, > > I don't know if this will help, but here are some links I pulled > together from different folders in the links section (if the link is > more than one line long, you'll need to copy and paste the entire link > to your address bar to get directed correctly): > > DOCband is FDA approved for use on infants 3 - 18 months of age. > http://www.fda.gov/cdrh/pdf/k964992.pdf > > > AAP Release July 2003 > Prevention & Management of Positional Skull Deformities in Infants - > AAP finally acknowledges relationship of " back to sleep " in increase > in plagio! Excerpt: " " The best response for helmets occurs in the age > range of 4 to 12 months because of the greater malleability of the > young infant skull bone and the normalizing effect of the rapid growth > of the brain. There is less modification of the cranial configuration > when used after 12 months of age. " > http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/ 1/ > 199?fulltext=plagiocephaly & searchid=QID_NOT_SET > > Treatment of the " older " infant with plagiocephaly > This study documents that even though early intervention is best, > treatment can still be successful even if the child is older than 12 > months of age. Excerpt: " " Through a series of case reports, they > present evidence that this treatment remains viable during the 2nd > year of life and that improvement has been observed in infants in whom > treatment has been initiated as late as 18 months. " > http://www.aans.org/education/journal/neurosurgical/sep00/9-3- 5.pdf > > Healthlink Medical Policy: CRANIAL ORTHOSIS FOR NON-SYNOSTOTIC > PLAGIOCEPHALY > Cranial orthosis is considered INVESTIGATIONAL/NOT MEDICALLY NECESSARY > as a treatment of nonsynostotic plagiocephaly as a technique to > prevent or modify potential associated functional impairments. Cranial > orthosis as a treatment of nonsynostotic plagiocephaly may be > considered eligible for coverage as a reconstructive > procedure/technique* in patients who meet the following criteria. *The > specific contract language regarding the scope of reconstructive > benefits must be reviewed to determine coverage eligibility. For > example, some, but not all contracts may consider repair of congenital > abnormalities as a coverage-eligible reconstructive service. Coverage > eligibility of acquired nonsynostotic plagiocephaly, as a result of > post natal positioning, may also be subject to contractual definition > of reconstructive services. State mandates may also apply. Cranial > orthoses are ineffective and NOT MEDICALLY NECESSARY in children aged > 18 months and over. Excerpt: " " For children greater than 6 months of > age but less than 18 months " > http://www.healthlink.com/provider/medpolicy/policies/durable/externa l_ > molding.html > > Plagiocephaly and brachycephaly in the first two years of life: a > prospective cohort study > (This study supports natural correction. it does show however, that > natural correction occurred from 12 months old to 24 months old in the > group of infants studied, so one could infer that bands ought to work > even better.) Excerpt: " Prevalence of either plagiocephaly or > brachycephaly or both increased between 6 weeks and 4 months, > decreased to one third of the 4-month level by 1 year, and then halved > again by 2 years. " > http://www.findarticles.com/p/articles/mi_m0950/is_4_114/ai_n6256703 > > If I find anything else that may help, even if it's a stretch, I'll > post. > > Good luck with your appeal, > > Christie (Mom to Repo'd Remy) > > > > --- In Plagiocephaly , " osmom55 " <warrmiano@s...> wrote: > > hi everyone - we were just denied coverage for our 2nd doc band and > > their reason was that there is no real proof that after 12 months > old > > and 4 months in one band - a second one was not going to do much. > does > > anyone have any resources i can use for our second appeal? any > > literature i can use to back up my opinion that it will work (even > if > > it doesn't - it is worth trying!!!!) > > thank you!! > > jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2005 Report Share Posted July 16, 2005 WOW!! I think I will use some of those links! --- In Plagiocephaly , " redlocks2003 " <redlocks@b...> wrote: > Jen, > > I don't know if this will help, but here are some links I pulled > together from different folders in the links section (if the link is > more than one line long, you'll need to copy and paste the entire link > to your address bar to get directed correctly): > > DOCband is FDA approved for use on infants 3 - 18 months of age. > http://www.fda.gov/cdrh/pdf/k964992.pdf > > > AAP Release July 2003 > Prevention & Management of Positional Skull Deformities in Infants - > AAP finally acknowledges relationship of " back to sleep " in increase > in plagio! Excerpt: " " The best response for helmets occurs in the age > range of 4 to 12 months because of the greater malleability of the > young infant skull bone and the normalizing effect of the rapid growth > of the brain. There is less modification of the cranial configuration > when used after 12 months of age. " > http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/ 1/ > 199?fulltext=plagiocephaly & searchid=QID_NOT_SET > > Treatment of the " older " infant with plagiocephaly > This study documents that even though early intervention is best, > treatment can still be successful even if the child is older than 12 > months of age. Excerpt: " " Through a series of case reports, they > present evidence that this treatment remains viable during the 2nd > year of life and that improvement has been observed in infants in whom > treatment has been initiated as late as 18 months. " > http://www.aans.org/education/journal/neurosurgical/sep00/9-3- 5.pdf > > Healthlink Medical Policy: CRANIAL ORTHOSIS FOR NON-SYNOSTOTIC > PLAGIOCEPHALY > Cranial orthosis is considered INVESTIGATIONAL/NOT MEDICALLY NECESSARY > as a treatment of nonsynostotic plagiocephaly as a technique to > prevent or modify potential associated functional impairments. Cranial > orthosis as a treatment of nonsynostotic plagiocephaly may be > considered eligible for coverage as a reconstructive > procedure/technique* in patients who meet the following criteria. *The > specific contract language regarding the scope of reconstructive > benefits must be reviewed to determine coverage eligibility. For > example, some, but not all contracts may consider repair of congenital > abnormalities as a coverage-eligible reconstructive service. Coverage > eligibility of acquired nonsynostotic plagiocephaly, as a result of > post natal positioning, may also be subject to contractual definition > of reconstructive services. State mandates may also apply. Cranial > orthoses are ineffective and NOT MEDICALLY NECESSARY in children aged > 18 months and over. Excerpt: " " For children greater than 6 months of > age but less than 18 months " > http://www.healthlink.com/provider/medpolicy/policies/durable/externa l_ > molding.html > > Plagiocephaly and brachycephaly in the first two years of life: a > prospective cohort study > (This study supports natural correction. it does show however, that > natural correction occurred from 12 months old to 24 months old in the > group of infants studied, so one could infer that bands ought to work > even better.) Excerpt: " Prevalence of either plagiocephaly or > brachycephaly or both increased between 6 weeks and 4 months, > decreased to one third of the 4-month level by 1 year, and then halved > again by 2 years. " > http://www.findarticles.com/p/articles/mi_m0950/is_4_114/ai_n6256703 > > If I find anything else that may help, even if it's a stretch, I'll > post. > > Good luck with your appeal, > > Christie (Mom to Repo'd Remy) > > > > --- In Plagiocephaly , " osmom55 " <warrmiano@s...> wrote: > > hi everyone - we were just denied coverage for our 2nd doc band and > > their reason was that there is no real proof that after 12 months > old > > and 4 months in one band - a second one was not going to do much. > does > > anyone have any resources i can use for our second appeal? any > > literature i can use to back up my opinion that it will work (even > if > > it doesn't - it is worth trying!!!!) > > thank you!! > > jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2005 Report Share Posted July 16, 2005 thank you so much - i'm just starting to pull info for our 2nd appeal and that is so helpful - i used the ins info for our first appeal - but wasn't looking specifically for info to back up their reason - as wew didn't know it yet and the thought of doing all that work again for another reason is so frustrating and takes up so much time that i don't always have!!!! has anyone out there done more than one appeal? any advice?? it just makes me want to cry sometimes when i deal with insurance!!! we still haven't received our check from the first one - which was approved and they have issued the check twice - but it mysteriously never shows up!!! thanks again!! ~jen --- In Plagiocephaly , " redlocks2003 " <redlocks@b...> wrote: > Jen, > > I don't know if this will help, but here are some links I pulled > together from different folders in the links section (if the link is > more than one line long, you'll need to copy and paste the entire link > to your address bar to get directed correctly): > > DOCband is FDA approved for use on infants 3 - 18 months of age. > http://www.fda.gov/cdrh/pdf/k964992.pdf > > > AAP Release July 2003 > Prevention & Management of Positional Skull Deformities in Infants - > AAP finally acknowledges relationship of " back to sleep " in increase > in plagio! Excerpt: " " The best response for helmets occurs in the age > range of 4 to 12 months because of the greater malleability of the > young infant skull bone and the normalizing effect of the rapid growth > of the brain. There is less modification of the cranial configuration > when used after 12 months of age. " > http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/ 1/ > 199?fulltext=plagiocephaly & searchid=QID_NOT_SET > > Treatment of the " older " infant with plagiocephaly > This study documents that even though early intervention is best, > treatment can still be successful even if the child is older than 12 > months of age. Excerpt: " " Through a series of case reports, they > present evidence that this treatment remains viable during the 2nd > year of life and that improvement has been observed in infants in whom > treatment has been initiated as late as 18 months. " > http://www.aans.org/education/journal/neurosurgical/sep00/9-3- 5.pdf > > Healthlink Medical Policy: CRANIAL ORTHOSIS FOR NON-SYNOSTOTIC > PLAGIOCEPHALY > Cranial orthosis is considered INVESTIGATIONAL/NOT MEDICALLY NECESSARY > as a treatment of nonsynostotic plagiocephaly as a technique to > prevent or modify potential associated functional impairments. Cranial > orthosis as a treatment of nonsynostotic plagiocephaly may be > considered eligible for coverage as a reconstructive > procedure/technique* in patients who meet the following criteria. *The > specific contract language regarding the scope of reconstructive > benefits must be reviewed to determine coverage eligibility. For > example, some, but not all contracts may consider repair of congenital > abnormalities as a coverage-eligible reconstructive service. Coverage > eligibility of acquired nonsynostotic plagiocephaly, as a result of > post natal positioning, may also be subject to contractual definition > of reconstructive services. State mandates may also apply. Cranial > orthoses are ineffective and NOT MEDICALLY NECESSARY in children aged > 18 months and over. Excerpt: " " For children greater than 6 months of > age but less than 18 months " > http://www.healthlink.com/provider/medpolicy/policies/durable/externa l_ > molding.html > > Plagiocephaly and brachycephaly in the first two years of life: a > prospective cohort study > (This study supports natural correction. it does show however, that > natural correction occurred from 12 months old to 24 months old in the > group of infants studied, so one could infer that bands ought to work > even better.) Excerpt: " Prevalence of either plagiocephaly or > brachycephaly or both increased between 6 weeks and 4 months, > decreased to one third of the 4-month level by 1 year, and then halved > again by 2 years. " > http://www.findarticles.com/p/articles/mi_m0950/is_4_114/ai_n6256703 > > If I find anything else that may help, even if it's a stretch, I'll > post. > > Good luck with your appeal, > > Christie (Mom to Repo'd Remy) > > > > --- In Plagiocephaly , " osmom55 " <warrmiano@s...> wrote: > > hi everyone - we were just denied coverage for our 2nd doc band and > > their reason was that there is no real proof that after 12 months > old > > and 4 months in one band - a second one was not going to do much. > does > > anyone have any resources i can use for our second appeal? any > > literature i can use to back up my opinion that it will work (even > if > > it doesn't - it is worth trying!!!!) > > thank you!! > > jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 16, 2005 Report Share Posted July 16, 2005 thank you so much - i'm just starting to pull info for our 2nd appeal and that is so helpful - i used the ins info for our first appeal - but wasn't looking specifically for info to back up their reason - as wew didn't know it yet and the thought of doing all that work again for another reason is so frustrating and takes up so much time that i don't always have!!!! has anyone out there done more than one appeal? any advice?? it just makes me want to cry sometimes when i deal with insurance!!! we still haven't received our check from the first one - which was approved and they have issued the check twice - but it mysteriously never shows up!!! thanks again!! ~jen --- In Plagiocephaly , " redlocks2003 " <redlocks@b...> wrote: > Jen, > > I don't know if this will help, but here are some links I pulled > together from different folders in the links section (if the link is > more than one line long, you'll need to copy and paste the entire link > to your address bar to get directed correctly): > > DOCband is FDA approved for use on infants 3 - 18 months of age. > http://www.fda.gov/cdrh/pdf/k964992.pdf > > > AAP Release July 2003 > Prevention & Management of Positional Skull Deformities in Infants - > AAP finally acknowledges relationship of " back to sleep " in increase > in plagio! Excerpt: " " The best response for helmets occurs in the age > range of 4 to 12 months because of the greater malleability of the > young infant skull bone and the normalizing effect of the rapid growth > of the brain. There is less modification of the cranial configuration > when used after 12 months of age. " > http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/ 1/ > 199?fulltext=plagiocephaly & searchid=QID_NOT_SET > > Treatment of the " older " infant with plagiocephaly > This study documents that even though early intervention is best, > treatment can still be successful even if the child is older than 12 > months of age. Excerpt: " " Through a series of case reports, they > present evidence that this treatment remains viable during the 2nd > year of life and that improvement has been observed in infants in whom > treatment has been initiated as late as 18 months. " > http://www.aans.org/education/journal/neurosurgical/sep00/9-3- 5.pdf > > Healthlink Medical Policy: CRANIAL ORTHOSIS FOR NON-SYNOSTOTIC > PLAGIOCEPHALY > Cranial orthosis is considered INVESTIGATIONAL/NOT MEDICALLY NECESSARY > as a treatment of nonsynostotic plagiocephaly as a technique to > prevent or modify potential associated functional impairments. Cranial > orthosis as a treatment of nonsynostotic plagiocephaly may be > considered eligible for coverage as a reconstructive > procedure/technique* in patients who meet the following criteria. *The > specific contract language regarding the scope of reconstructive > benefits must be reviewed to determine coverage eligibility. For > example, some, but not all contracts may consider repair of congenital > abnormalities as a coverage-eligible reconstructive service. Coverage > eligibility of acquired nonsynostotic plagiocephaly, as a result of > post natal positioning, may also be subject to contractual definition > of reconstructive services. State mandates may also apply. Cranial > orthoses are ineffective and NOT MEDICALLY NECESSARY in children aged > 18 months and over. Excerpt: " " For children greater than 6 months of > age but less than 18 months " > http://www.healthlink.com/provider/medpolicy/policies/durable/externa l_ > molding.html > > Plagiocephaly and brachycephaly in the first two years of life: a > prospective cohort study > (This study supports natural correction. it does show however, that > natural correction occurred from 12 months old to 24 months old in the > group of infants studied, so one could infer that bands ought to work > even better.) Excerpt: " Prevalence of either plagiocephaly or > brachycephaly or both increased between 6 weeks and 4 months, > decreased to one third of the 4-month level by 1 year, and then halved > again by 2 years. " > http://www.findarticles.com/p/articles/mi_m0950/is_4_114/ai_n6256703 > > If I find anything else that may help, even if it's a stretch, I'll > post. > > Good luck with your appeal, > > Christie (Mom to Repo'd Remy) > > > > --- In Plagiocephaly , " osmom55 " <warrmiano@s...> wrote: > > hi everyone - we were just denied coverage for our 2nd doc band and > > their reason was that there is no real proof that after 12 months > old > > and 4 months in one band - a second one was not going to do much. > does > > anyone have any resources i can use for our second appeal? any > > literature i can use to back up my opinion that it will work (even > if > > it doesn't - it is worth trying!!!!) > > thank you!! > > jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2006 Report Share Posted June 6, 2006 Our ins. (thru dh's work) normally doesn't cover any of it. It just so happens that Dh's company had that added to the coverage years ago. Who knew it would come in so handy?!?!?! Our's covers 80% - we have to pay 20% - $500 Jen Mommy to 4...and 1 more!!!! LULI'S HERE! "Luli" www.babiesonline.com/babies/j/jens5th/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2006 Report Share Posted June 6, 2006 Our STARband was considered Durable Medical Equipment so our insurance covered 80%. We paid 20% which was $560. Molly California Nicolas, 8 months, tort & plagio, STARband 4/25/06 , 3 , 6.5 -----Original Message-----From: Plagiocephaly [mailto:Plagiocephaly ] On Behalf Of and AleySent: 5 June 2006 4:13 AMPlagiocephaly ; AllAboutPlagiocephaly Subject: insurance question How much do insurance companies pay? Mine did not even balk when asked. They said that because it was out of network it would be 60/40. SO we have to pay 600. It still hurts though!!!!!I just wondered what was the norm? Thanks and have a great day, aleyfamily@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2006 Report Share Posted June 6, 2006 If I want the Band it is 2800 dollars and the Clarren Helmet is 2000. My insurance Regence BS didn't want to pay a dime. But I convinced them and now they will pay. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2006 Report Share Posted June 6, 2006 My insurance (BCBS of FL) doesn't cover any of it, so we're appealing. If it were covered they would pay 80% which would mean I'd pay 20% ($400) out of pocket. Alison mom to Leila, 8 months (tort/plagio - STARband 6/5/06)Boynton Beach, FL Plagiocephaly From: DVJen@...Date: Tue, 6 Jun 2006 11:40:59 -0400Subject: Re: insurance question Our ins. (thru dh's work) normally doesn't cover any of it. It just so happens that Dh's company had that added to the coverage years ago. Who knew it would come in so handy?!?!?! Our's covers 80% - we have to pay 20% - $500 JenMommy to 4...and 1 more!!!!LULI'S HERE!"Luli"www.babiesonline.com/babies/j/jens5th/ Express yourself instantly with MSN Messenger! MSN Messenger Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2006 Report Share Posted June 6, 2006 , That's great that your insurance paid. Who do you have? I have United Healthcare, and they denied us - they consider it a cosmetic treatment. You're lucky - I am appealing, but had to pay $3750 out of pocket for our Doc band. Would have loved to pay only $600! Good luck with the treatment! Cris in Houston Mom to , 7 months DOC band 5/26/06 > > How much do insurance companies pay? Mine did not even balk when asked. They > said that because it was out of network it would be 60/40. SO we have to pay > 600. It still hurts though!!!!!I just wondered what was the norm? > > > > Thanks and have a great day, > > > > aleyfamily@... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2006 Report Share Posted June 6, 2006 It depends on your plan but we were told we had to wait for an answer one way or another to cast - otherwise it would be an automatic denial based on failure to obtain approval. They denied us anyway (called it a cosmetic procedure) but we can now appeal that, but there is no good way to appeal failing to obtain approval. Good luck! > > > > >Tami > > > We went ahead and got the DOC band last week - and haven't received > conformation from our insurance company (Medichoice) yet.. I just > asked them to send me a letter stating we would not be penalized for > proceeding. > Good Luck! > > Debby and Zack 8/2/00 NJ > > >I could use some advice please. Has anyone gone ahead and started > >the casting process etc. without yet receiving insurance > >authorization. We are due to get casted on Monday but our insurance > >has not yet given authorization. My neurosurgeons secretary tells me > >it will be okay to go ahead with it. She says they should > >definately authorize it (they have before for other patients they > >have) and she tells me the date will be the date they sent the > >referral to the insurance company. She says they will still cover > >even if I start before it is actually authorized. This makes me very > >nervous. I plan on paying even if my insurance doesn't but I don't > >want to blow it if they will. I have Cigna but it is contracted out > >to Hills Physician. It's confusing. > > > >Thank you, > >Tami and Luke > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.