Re: Anyone in NJ, help please!

[Guest guest]

Hi ,

I am also in NJ and my son started out with severe brachycephaly (CI of 100%).

I have United HealthCare and, initially, they told me they would pay for a

helmet but only for a Hanger. I was not so impressed by the helmet or the

facility in Edison and went with my gut instinct and got my son a DOC Band at

Cranial Technologies in Paramus. The first band did go towards my out-of-network

deductible for 2009 (got it 12/23/09). We paid $3300 through Care Credit (0%

interest for 12 months).

My son has since received a 2nd DOC Band and my insurance, UHC, this time

wouldn't put this toward the deductible, noting the exclusion in our policy for

othotic devices—including helmets. I honestly haven't appealed because I figured

what was the point?

My personal opinion—and I am by no means that well versed in any of the other

companies or types of helmets—is that Cranial Technologies and the DOC Band is

the best. And I'd rather be in debt (as I did charge the 2nd band to my Visa

and I don't have the money for it) than not do the best for my child.

I truly believe that the DOC Band is a great product and my son's brachy has

improved greatly. I don't know how to add pics here, but if you want to see his

2nd DSi pics, I'll post the links below.

So my 2 cents is to go to Cranial Technologies. But that's my opinion. You need

to go with your gut instinct.

Robyn

's pics after 6 weeks in his 1st DOC Band. CI went from 100% to 92.2%.

http://lh5.ggpht.com/_kp-_rCSzhSw/S2s8tV_Qk9I/AAAAAAAAEOg/JvvNqcaN5qE/s800/IMG_0\

233.jpg

http://lh4.ggpht.com/_kp-_rCSzhSw/S2s8uGf4w2I/AAAAAAAAEOk/Py4rZWzGTag/s800/IMG_0\

234.jpg

http://lh5.ggpht.com/_kp-_rCSzhSw/S2s8uyXqQ7I/AAAAAAAAEOs/T95fOd3Gxhg/s800/IMG_0\

235.jpg

>

> I posted about a week and a half or so ago for some advice regarding where to

take our daughter Katelyn for a consultation. Based on that advice we took her

to Cranial Technologies in Paramus, NJ and decided that we are getting her a

DOCband whether insurance pays for it or not. She has her scan this Wednesday

and she'll be getting it on 3/31. Anyway, we have Horizon BCBSNJ insurance and

and it has been an absolute nightmare dealing with them. I have kept a log of

all the conversations (8) that I have had with them over the past 2 weeks - who

I spoke with, what they said, etc. Initially they told us there was nowhere in

netwrok that we could go. We have an HMO plan. They advised us to have our

pediatrician call for out of network authroization. They did, and were told

that Cranial Technologies was in network. We took her there, and when CT called

after our consultation, we were told that they were not in network. We were

told to go to Hanger Orthotics. I researched it and the only locations that do

the cranial orthotics are more than 50 miles from home. So I called Horizon and

was told there were no other places in network. So on Tuesday our pediatrician

called once again to get out of network authorization and today called back to

check on the process. And today we are told that there are 2 other locations in

NJ that are in network:

>

> Next Step Orthopedics in West Orange, NJ and NOPCO a division of Children's

Hospital in Mountainside, NJ.

>

> I am so disgusted with Horizon and annoyed that they could not have provided

us with all of the correct information initially, but am hoping it may work in

our favor. Since they did instruct us to go to Cranial Technologies I am hoping

that may be helpful if we appeal - we went there because they told us it was in

network (and because we heard it was the best.)

> As I said, we are definitely going to CT but I would like to gather some

information about these other places to possibly make an appeal to the insurance

company. It is my understanding that certain bands are more effective than

others, and certain brands are better for brachy (which my daughter has.) I

can't find any information about what kinds of bands they use at these locations

or any comments from people who have been there. I'm wondering if anyone has

heard of either. If you made it all the way through this, thanks for reading.

This site is a wonderful resource.

>

[Guest guest]

Hi & Robyn,

Below is information that I posted a few weeks ago. Not sure if you got to read

it or if it will help.

Robyn - If you live in NJ I would definitly appeal. Try to find out what billing

code Cranial Technologies used. I will try to go back and find my other posting

which might also be of some help...maryleah

Hi ,My name is leah and I live in South Brunswick Township. Where do you

live in New Jersey?

My daughter, who is six months old, will be getting her Doc Band from Cranial

Technologies in Paramus next Tuesday. After a lot of research, I discovered that

there is a mandate in New Jersey that requires any company that offers a policy

to NJ residents to cover orthotic and prosthetic devices.

We had to make reference to a specific billing code S1040, when discussing this

with our Health care provider - United Health Care.

We also had to get a perscription and a letter of medical necessity from our

pediatrician.They agreed to pay for the cost of the band and visits at our

out-of-network rate.

We also went to Nouveau Orthotics and Prosthetics in Hazlet for an initial

consultation (They use the Starband), but decided to go with the Doc Band.Hope

this information helps. Let me know if you have any further question....maryleah

>

> I posted about a week and a half or so ago for some advice regarding where to

take our daughter Katelyn for a consultation. Based on that advice we took her

to Cranial Technologies in Paramus, NJ and decided that we are getting her a

DOCband whether insurance pays for it or not. She has her scan this Wednesday

and she'll be getting it on 3/31. Anyway, we have Horizon BCBSNJ insurance and

and it has been an absolute nightmare dealing with them. I have kept a log of

all the conversations (8) that I have had with them over the past 2 weeks - who

I spoke with, what they said, etc. Initially they told us there was nowhere in

netwrok that we could go. We have an HMO plan. They advised us to have our

pediatrician call for out of network authroization. They did, and were told

that Cranial Technologies was in network. We took her there, and when CT called

after our consultation, we were told that they were not in network. We were

told to go to Hanger Orthotics. I researched it and the only locations that do

the cranial orthotics are more than 50 miles from home. So I called Horizon and

was told there were no other places in network. So on Tuesday our pediatrician

called once again to get out of network authorization and today called back to

check on the process. And today we are told that there are 2 other locations in

NJ that are in network:

>

> Next Step Orthopedics in West Orange, NJ and NOPCO a division of Children's

Hospital in Mountainside, NJ.

>

> I am so disgusted with Horizon and annoyed that they could not have provided

us with all of the correct information initially, but am hoping it may work in

our favor. Since they did instruct us to go to Cranial Technologies I am hoping

that may be helpful if we appeal - we went there because they told us it was in

network (and because we heard it was the best.)

> As I said, we are definitely going to CT but I would like to gather some

information about these other places to possibly make an appeal to the insurance

company. It is my understanding that certain bands are more effective than

others, and certain brands are better for brachy (which my daughter has.) I

can't find any information about what kinds of bands they use at these locations

or any comments from people who have been there. I'm wondering if anyone has

heard of either. If you made it all the way through this, thanks for reading.

This site is a wonderful resource.

>

[Guest guest]

& Robyn,

This is the other information I posted several weeks ago.

Hope it may help...maryleah

My daughter is almost six months old and she has brachycephaly.

We went for an evaluation at Cranial Technologies a few weeks ago.

We are going to CT on Tuesday for her 3D imaging for her doc band.

Since the evaluation, I have been trying to educate myself on

brachycephaly as well as trying to understand what our insurance will and will

not cover.

In my research, I have learned that there is a New Jersey Mandate on Prosthetic

and Orthotic devices. Basically, this means even if your insurance does not

normally cover a helmet/band(and even if they have an exclusion in your

policy)they are still obligated to follow this New Jersey Mandate as long as

they continue to offer Health Care Insurance in New Jersey.

After calling United Health Care and discussing this New Jersey mandate, I was

told that they will cover the helmet and treatment at Cranial Technologies at

our out of network rate (70%) and after our deductible has been met. I believe

you need to ask your healthcare provider to look under the billing code of S1040

to get the information on this mandate.

Hope this helps!

>

> I posted about a week and a half or so ago for some advice regarding where to

take our daughter Katelyn for a consultation. Based on that advice we took her

to Cranial Technologies in Paramus, NJ and decided that we are getting her a

DOCband whether insurance pays for it or not. She has her scan this Wednesday

and she'll be getting it on 3/31. Anyway, we have Horizon BCBSNJ insurance and

and it has been an absolute nightmare dealing with them. I have kept a log of

all the conversations (8) that I have had with them over the past 2 weeks - who

I spoke with, what they said, etc. Initially they told us there was nowhere in

netwrok that we could go. We have an HMO plan. They advised us to have our

pediatrician call for out of network authroization. They did, and were told

that Cranial Technologies was in network. We took her there, and when CT called

after our consultation, we were told that they were not in network. We were

told to go to Hanger Orthotics. I researched it and the only locations that do

the cranial orthotics are more than 50 miles from home. So I called Horizon and

was told there were no other places in network. So on Tuesday our pediatrician

called once again to get out of network authorization and today called back to

check on the process. And today we are told that there are 2 other locations in

NJ that are in network:

>

> Next Step Orthopedics in West Orange, NJ and NOPCO a division of Children's

Hospital in Mountainside, NJ.

>

> I am so disgusted with Horizon and annoyed that they could not have provided

us with all of the correct information initially, but am hoping it may work in

our favor. Since they did instruct us to go to Cranial Technologies I am hoping

that may be helpful if we appeal - we went there because they told us it was in

network (and because we heard it was the best.)

> As I said, we are definitely going to CT but I would like to gather some

information about these other places to possibly make an appeal to the insurance

company. It is my understanding that certain bands are more effective than

others, and certain brands are better for brachy (which my daughter has.) I

can't find any information about what kinds of bands they use at these locations

or any comments from people who have been there. I'm wondering if anyone has

heard of either. If you made it all the way through this, thanks for reading.

This site is a wonderful resource.

>

[Guest guest]

Yeah... I know about the mandate and I'm not sure how to get UHC to at least

apply the cost towards our deductible. Honestly, they won't pay anything--our

deductible is high--so that's why I'm not really fighting. But I'll see if I can

draft a simple letter.

Thank you for bringing it up again.

> >

> > I posted about a week and a half or so ago for some advice regarding where

to take our daughter Katelyn for a consultation. Based on that advice we took

her to Cranial Technologies in Paramus, NJ and decided that we are getting her a

DOCband whether insurance pays for it or not. She has her scan this Wednesday

and she'll be getting it on 3/31. Anyway, we have Horizon BCBSNJ insurance and

and it has been an absolute nightmare dealing with them. I have kept a log of

all the conversations (8) that I have had with them over the past 2 weeks - who

I spoke with, what they said, etc. Initially they told us there was nowhere in

netwrok that we could go. We have an HMO plan. They advised us to have our

pediatrician call for out of network authroization. They did, and were told

that Cranial Technologies was in network. We took her there, and when CT called

after our consultation, we were told that they were not in network. We were

told to go to Hanger Orthotics. I researched it and the only locations that do

the cranial orthotics are more than 50 miles from home. So I called Horizon and

was told there were no other places in network. So on Tuesday our pediatrician

called once again to get out of network authorization and today called back to

check on the process. And today we are told that there are 2 other locations in

NJ that are in network:

> >

> > Next Step Orthopedics in West Orange, NJ and NOPCO a division of Children's

Hospital in Mountainside, NJ.

> >

> > I am so disgusted with Horizon and annoyed that they could not have provided

us with all of the correct information initially, but am hoping it may work in

our favor. Since they did instruct us to go to Cranial Technologies I am hoping

that may be helpful if we appeal - we went there because they told us it was in

network (and because we heard it was the best.)

> > As I said, we are definitely going to CT but I would like to gather some

information about these other places to possibly make an appeal to the insurance

company. It is my understanding that certain bands are more effective than

others, and certain brands are better for brachy (which my daughter has.) I

can't find any information about what kinds of bands they use at these locations

or any comments from people who have been there. I'm wondering if anyone has

heard of either. If you made it all the way through this, thanks for reading.

This site is a wonderful resource.

> >

>

[Guest guest]

Hi,

We are in the process of appealing as well. Our Cigna policy has a specific

exclusion for cranial orthotics. I have read about the mandate but was told

since my husband works in Manhattan and the policy is out of NY the mandate does

not apply. Anyone have any luck in this situation??

Thanks!

> >

> > I posted about a week and a half or so ago for some advice regarding where

to take our daughter Katelyn for a consultation. Based on that advice we took

her to Cranial Technologies in Paramus, NJ and decided that we are getting her a

DOCband whether insurance pays for it or not. She has her scan this Wednesday

and she'll be getting it on 3/31. Anyway, we have Horizon BCBSNJ insurance and

and it has been an absolute nightmare dealing with them. I have kept a log of

all the conversations (8) that I have had with them over the past 2 weeks - who

I spoke with, what they said, etc. Initially they told us there was nowhere in

netwrok that we could go. We have an HMO plan. They advised us to have our

pediatrician call for out of network authroization. They did, and were told

that Cranial Technologies was in network. We took her there, and when CT called

after our consultation, we were told that they were not in network. We were

told to go to Hanger Orthotics. I researched it and the only locations that do

the cranial orthotics are more than 50 miles from home. So I called Horizon and

was told there were no other places in network. So on Tuesday our pediatrician

called once again to get out of network authorization and today called back to

check on the process. And today we are told that there are 2 other locations in

NJ that are in network:

> >

> > Next Step Orthopedics in West Orange, NJ and NOPCO a division of Children's

Hospital in Mountainside, NJ.

> >

> > I am so disgusted with Horizon and annoyed that they could not have provided

us with all of the correct information initially, but am hoping it may work in

our favor. Since they did instruct us to go to Cranial Technologies I am hoping

that may be helpful if we appeal - we went there because they told us it was in

network (and because we heard it was the best.)

> > As I said, we are definitely going to CT but I would like to gather some

information about these other places to possibly make an appeal to the insurance

company. It is my understanding that certain bands are more effective than

others, and certain brands are better for brachy (which my daughter has.) I

can't find any information about what kinds of bands they use at these locations

or any comments from people who have been there. I'm wondering if anyone has

heard of either. If you made it all the way through this, thanks for reading.

This site is a wonderful resource.

> >

>

[Guest guest]

Hi Robyn,

Your son's pictures look amazing! Congrats on such great success. Just

wondering how old he was when he started. My son is on week 2 and I think I

already see a significant difference. Just hoping to be in it less than the

quoted 12-16 weeks. Thanks!

> >

> > I posted about a week and a half or so ago for some advice regarding where

to take our daughter Katelyn for a consultation. Based on that advice we took

her to Cranial Technologies in Paramus, NJ and decided that we are getting her a

DOCband whether insurance pays for it or not. She has her scan this Wednesday

and she'll be getting it on 3/31. Anyway, we have Horizon BCBSNJ insurance and

and it has been an absolute nightmare dealing with them. I have kept a log of

all the conversations (8) that I have had with them over the past 2 weeks - who

I spoke with, what they said, etc. Initially they told us there was nowhere in

netwrok that we could go. We have an HMO plan. They advised us to have our

pediatrician call for out of network authroization. They did, and were told

that Cranial Technologies was in network. We took her there, and when CT called

after our consultation, we were told that they were not in network. We were

told to go to Hanger Orthotics. I researched it and the only locations that do

the cranial orthotics are more than 50 miles from home. So I called Horizon and

was told there were no other places in network. So on Tuesday our pediatrician

called once again to get out of network authorization and today called back to

check on the process. And today we are told that there are 2 other locations in

NJ that are in network:

> >

> > Next Step Orthopedics in West Orange, NJ and NOPCO a division of Children's

Hospital in Mountainside, NJ.

> >

> > I am so disgusted with Horizon and annoyed that they could not have provided

us with all of the correct information initially, but am hoping it may work in

our favor. Since they did instruct us to go to Cranial Technologies I am hoping

that may be helpful if we appeal - we went there because they told us it was in

network (and because we heard it was the best.)

> > As I said, we are definitely going to CT but I would like to gather some

information about these other places to possibly make an appeal to the insurance

company. It is my understanding that certain bands are more effective than

others, and certain brands are better for brachy (which my daughter has.) I

can't find any information about what kinds of bands they use at these locations

or any comments from people who have been there. I'm wondering if anyone has

heard of either. If you made it all the way through this, thanks for reading.

This site is a wonderful resource.

> >

>