Re: Tips for Speeding up the Process?

December 5, 2009

Wow--thanks so much to you and to all the others who have responded thus far for

taking the time to respond in such detail. The information is so helpful and

gives me some confidence and a more clear picture of how to move forward.

I think we'll give the insurance a call to find out if there's a specific kind

of band they cover since that may play a role in our decision about which band

to use; I don't, however, think we'll waste any time waiting for them. I don't

feel all that hopeful that they're going to cover it. I feel grateful that at

this time we have the money to pay out of pocket for the band; sure, it means

we'll give up other things we were hoping to do (home improvements, etc.) but

it's certainly worth it. We'll do our best to get reiumbursed from UHC, but I'm

not gonna wait for them.

Jill, did you have to pay out of pocket for both bands? My worry about a

DOCband would be if we have to pay twice--that could be more than we could do

out of pocket. Especially if we decide to do DOCband. We'll be travelling 6

hrs. each way to Pasadena, so there will be travel expenses, plus the strain on

the family (I have three older girls, ages 7, 5, and 3). Still, if the DOCband

has a better chance of working, it may be worth the sacrifices.

This will probably seem like a dumb question, but what exactly is the

Certificate of Coverage? Is that in our initial enrollment information, and

it's different for everyone depending on when you enrolled? Insurance is so

intimidating to me, and up until now, our healthcare has been pretty cut and

dry, so I'm not familiar with the workings of the insurance company.

Thanks again for all your help!

Mom to (8 months old)

Sacramento, CA

>

> Hi ,

>

> Welcome to the group. We've benefitted from it tremendously in the 7 months

we've been treating my son's plagio. It is a great resource.

>

> It was our third pediatrician who was the one to actually write the

prescription for our DOC Band. The first pediatricians and cranial facial

specialist said we didn't need to band - but the research we did convinced us

that we needed to, and quickly. We knew a family whose daughter had a DOC Band

so we contacted them to get the name of their pediatrician, since it sounded

like their pediatrician was pro-active about getting plagio kids treatment.

(Our friend's daughter was in a DOC Band by 4 months - per the recommendation of

this pediatrician.) We wanted to hurry things along, too, because we had also

lost some time listening to doctors early on, so we made our appointment with

Cranial Tech for the consult just about the same time we made our appointment

with the pediatrician. It helped that we were already pretty sure this new

pediatrician would write the prescription we needed. I think the appointments

ended up being a day apart - with the consult at CT first. When we got the

prescription from the ped the next day, we were already set with CT to move

ahead. So, within a few days, we were back at CT to get scanned and within

another 10 days, he was in the band. Timeline was pretty quick...just about 3

weeks. In the event the neurologist you're seeing next Friday gives you the

same advice as the other peds (which is entirely possible) - you might work this

week to find a pediatrician who has referred a family for a band and set up that

appointment. If you don't know any families who have banded - call the Starband

clinic and ask for names of pediatricians from whom they see referrals. That

could quicken the process if you don't get the prescription needed from the

specialist next Friday. And I would go ahead and set up the appointment either

with the Starband clinic or Cranial Tech - whichever you choose. I think it can

take a little while sometimes to get an appointment.

>

> Our son was 5 1/2 months old when he started band #1 and almost 9 months old

when he started band #2 (17 mm cranial vault asymmetry, initially).

>

> We also have UHC and CT told us at our consult that UHC was one of the most

difficult to work with for coverage. We ended up paying out-of-pocket after

exhausting all levels of the appeal process. We had an " exclusion " for cranial

bands in our Certificate of Coverage -- and my understanding is that they will

not make an exception if there is a specific exclusion in your CoC. Based on

what you shared regarding the language of your policy, it doesn't sound like an

exclusion is the issue. If that is the case, my guess is that you have at least

a chance of winning an appeal if they deny it at first. There is plenty of

research on untreated plagio that may sway the jury...submit it all if you do

have to appeal. I wouldn't wait to get the insurance thing settled before

proceeding. You can work on the insurance side of things while he's in the

band. That's assuming you can pay out-of-pocket or use Care Credit or some

other funding source to get going - and then work on getting reimbursed.

>

> That's a lot of info -- hope some of it is helpful. Keep us posted on your

progress.

>

> Jill

> Cade's mom (11 months, DOC Band #2, 09-29-09 - present)

> Austin TX

>

December 5, 2009

,

First, I know it's hard to not feel guilty, but you know you are doing

everything you can to help your son. 8 months isn't too late for treatment by

any stretch!

To answer your question, it took us about 10 days to get an appointment with

Cranial Tech (in Dallas). After the initial appt, we went back about a week

later for the 3D photos and 2 weeks to the day after that to pick up the Doc

Band. Our daughter was banded at 7 months to the day and has had tremendous

results. I remember at the time feeling like you do that every minute counted

and I was anxious to get her started ASAP. This is her 8th week and when we go

on Dec 14th we expect that to be either her last appointment or next to last,

depending on growth.

I know it's hard as the days pass, but at 8 months you WILL get results. I

would strongly urge you to call StarBand or Cranial Tech on Monday morning to

schedule an appointment. Doesn't hurt to get on their calendar. Sadly, your

biggest hurtle is going to be getting the referral.

Good Luck!

Jo Anne

Mom to (9 months)

Doc Band, 8 weeks

Dallas, TX

>

> Hi all. I've just joined and have learned so much from perusing this group's

postings. What a nice support group.

> A quick recap of my son's plagio history: At 3 months we noticed a flat spot

developing. Mentioned it to the Dr., who said it would go away w/ tummy time

and once he started rolling around. It didn't. Over the course of the next 4

months, I also asked two different nurse practitioner and another doctor in the

office about the flattening. All said it was nothing to be worried about and

would probably correct itself in time, or " it would just be like that forever. "

I even asked about whether we needed a helmet (I was unfamiliar with plagio, but

knew of some babies who had worn helmets) and was told no. I started to forget

about his head shape. Fast forward to Thanksgiving, when our visit to out of

town relatives led my Sister-in-law (who works in the medical field) to notice

's head shape and tell us we should get a second opinion, and quickly.

So this week I've poured over all the plagio info on the Internet, and I feel

certain that he has positional plagiocephaly, and likely at least a moderate

case of it. I am just sick about the fact that it's taken me so long to do this

research and angry that I listened to doctors who clearly didn't know what they

were talking about. How to deal with the guilt?

> We have an appt. set up with a reputable pediatric neurologist here in

Sacramento next Friday. My main concern now is that this process will all move

too slowly and delay what is already a late start for banding. He turned 8

months old this week. Any tips on things I could do to speed up the process?

Should I call my insurance provider (United Healthcare) in advance of our Dr.'s

office to inquire about their coverage of cranial orthotics? Is there usually a

long wait at places that do fittings for Starbands (in our area) or DOCbands

(our nearest CranialTech is in Pasadena, 6 hours away--yikes.)? If so, perhaps

I should try to make an appt. now so that it will be already set up if/when the

neurologist sends us that direction. I just hate that we waited so long to take

action, and now fear that the laborious process of getting this all going will

cut into the months of prime effectiveness for banding.

> Sorry for the long message. Any advice that anyone can give on speeding up

the process and/or dealing with UHC would be helpful and much appreciated. I

read UHC's medical policy about plagiocephaly online and it states that " Cranial

orthotic devices are cosmetic in infants with mild to moderate plagiocephaly.

There are no definitive data demonstrating that there are adverse health effects

associated with a mild to moderate degree of cranial asymmetry, and, therefore,

it is unclear whether treatment of these individuals provides a future health

benefit, or merely a cosmetic effect. " Doesn't sound good for our chances of

insurance paying.

> Thanks for your help! I think this group is going to be a great help to me as

we navigate this road.

>

December 5, 2009

,

We did have to pay out of pocket for both bands. We were able to pay for the first one up front and get the $300 discount, but we did the second one with Care Credit to spread out the payments. We really never even thought about the possibility of a second band being needed and CT thought he'd need only one. However, when he outgrew band #1, there was still lots of room for improvement in the cranial vault numbers. When you have your son measured, you'll have a better feel for what is likely (one band or two). That's always a guess - but I think if it's really severe, they tend to guess with some degree of accuracy the likelihood of needing a second band. All depends on how fast he's growing and where that growth ends up going. In our case, he had good growth/correction to facial asymmetry and skull base (ear misalignment) but not as much as we would have liked in the cranial vault. So - we went ahead with the second band. We are blessed to have a Cranial Tech in the city in which we live, so we never looked at or considered any other providers. They are a fantastic bunch and have been great walking us through this whole process, which was so overwhelming at first. We've seen them nearly every week for months now...I told my husband I'll be a little bit sad when we graduate and don't have our weekly visits with them! If you can commit to the travel requirements, I can't imagine you'd regret going with Cranial Tech. But I know there are lots of parents here who have had good results with other providers. Hopefully, you'll get some good feedback about those options.

The Certificate of Coverage is the document which contains all the details about what your policy covers and what it excludes. It wasn't included in our enrollment packet - I had to request it from our employer (who emailed it to me in a .pdf file). It was about 70+ pages in length. I didn't know much about our coverage either - but got quite an education having to go through the appeal process. Learned more than I ever wanted to know about it! Feel free to email me if you have questions about the appeal process. I'll help if I can. I got help from several parents here, too. Again, great support network!

Jill

Cade's mom (11 months, DOC Band #2, 09-29-09 -- present)

Austin TX

Re: Tips for Speeding up the Process?

Wow--thanks so much to you and to all the others who have responded thus far for taking the time to respond in such detail. The information is so helpful and gives me some confidence and a more clear picture of how to move forward.I think we'll give the insurance a call to find out if there's a specific kind of band they cover since that may play a role in our decision about which band to use; I don't, however, think we'll waste any time waiting for them. I don't feel all that hopeful that they're going to cover it. I feel grateful that at this time we have the money to pay out of pocket for the band; sure, it means we'll give up other things we were hoping to do (home improvements, etc.) but it's certainly worth it. We'll do our best to get reiumbursed from UHC, but I'm not gonna wait for them.Jill, did you have to pay out of pocket for both bands? My worry about a DOCband would be if we have to pay twice--that could be more than we could do out of pocket. Especially if we decide to do DOCband. We'll be travelling 6 hrs. each way to Pasadena, so there will be travel expenses, plus the strain on the family (I have three older girls, ages 7, 5, and 3). Still, if the DOCband has a better chance of working, it may be worth the sacrifices.This will probably seem like a dumb question, but what exactly is the Certificate of Coverage? Is that in our initial enrollment information, and it's different for everyone depending on when you enrolled? Insurance is so intimidating to me, and up until now, our healthcare has been pretty cut and dry, so I'm not familiar with the workings of the insurance company.Thanks again for all your help!Mom to (8 months old)Sacramento, CA>> Hi ,> > Welcome to the group. We've benefitted from it tremendously in the 7 months we've been treating my son's plagio. It is a great resource. > > It was our third pediatrician who was the one to actually write the prescription for our DOC Band. The first pediatricians and cranial facial specialist said we didn't need to band - but the research we did convinced us that we needed to, and quickly. We knew a family whose daughter had a DOC Band so we contacted them to get the name of their pediatrician, since it sounded like their pediatrician was pro-active about getting plagio kids treatment. (Our friend's daughter was in a DOC Band by 4 months - per the recommendation of this pediatrician.) We wanted to hurry things along, too, because we had also lost some time listening to doctors early on, so we made our appointment with Cranial Tech for the consult just about the same time we made our appointment with the pediatrician. It helped that we were already pretty sure this new pediatrician would write the prescription we needed. I think the appointments ended up being a day apart - with the consult at CT first. When we got the prescription from the ped the next day, we were already set with CT to move ahead. So, within a few days, we were back at CT to get scanned and within another 10 days, he was in the band. Timeline was pretty quick...just about 3 weeks. In the event the neurologist you're seeing next Friday gives you the same advice as the other peds (which is entirely possible) - you might work this week to find a pediatrician who has referred a family for a band and set up that appointment. If you don't know any families who have banded - call the Starband clinic and ask for names of pediatricians from whom they see referrals. That could quicken the process if you don't get the prescription needed from the specialist next Friday. And I would go ahead and set up the appointment either with the Starband clinic or Cranial Tech - whichever you choose. I think it can take a little while sometimes to get an appointment. > > Our son was 5 1/2 months old when he started band #1 and almost 9 months old when he started band #2 (17 mm cranial vault asymmetry, initially).> > We also have UHC and CT told us at our consult that UHC was one of the most difficult to work with for coverage. We ended up paying out-of-pocket after exhausting all levels of the appeal process. We had an "exclusion" for cranial bands in our Certificate of Coverage -- and my understanding is that they will not make an exception if there is a specific exclusion in your CoC. Based on what you shared regarding the language of your policy, it doesn't sound like an exclusion is the issue. If that is the case, my guess is that you have at least a chance of winning an appeal if they deny it at first. There is plenty of research on untreated plagio that may sway the jury...submit it all if you do have to appeal. I wouldn't wait to get the insurance thing settled before proceeding. You can work on the insurance side of things while he's in the band. That's assuming you can pay out-of-pocket or use Care Credit or some other funding source to get going - and then work on getting reimbursed. > > That's a lot of info -- hope some of it is helpful. Keep us posted on your progress. > > Jill> Cade's mom (11 months, DOC Band #2, 09-29-09 - present)> Austin TX>

December 6, 2009

We also live in Sac. Not sure if this is helpful, but we're insured through

Kaiser and our pediatrician (whom we don't like but gave us the referral) is Dr.

Doan in Roseville. We then saw Dr. Yokoo, a cranio-facial specialist, in the

Kaiser Richmond, who we also didn't like but gave us the referral for a band

through Hanger. Kaiser covered the full cost.

I know there's feelings about Docbands and Starbands being better than Hanger,

but a free helmet that works is a pretty good deal to me. Hope that gives you

an alternative to think about.

Best,

Mom to Alena, 9 months old

10 weeks in Hanger helmet, Sacramento, CA