Tips for Speeding up the Process?

[Guest guest]

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