Re: Insurance coverage for baby with severe brachy

[Guest guest]

I don't know how it is by state, but in NJ your insurance apparently HAS to

cover a helmet for moderate to severe cases. My son has brachy (CI of 100%) and

my insurance would have covered a Hanger helmet. We went with a DOC Band and the

amount went to our deductible.

I'd definitely appeal, and see if your insurance repays you. It's worth a shot.

There are pages and pages of appeal letters online†" and on this group.

I'm glad you've seen such an improvement. My son is 4.5 months and has been in

his band for 9 days. We've seen improvement already and knowing how much YOUR

son's head has changed gives me even more optimism.

>

> Hello all,

>

> In October, my son was fitted with a Hanger helmet. He had very mild plagio -

to be honest, I don't even remember the measurements for that, but since

beginning treatment, he has dropped into the normal range. Our main concern

with his head shape was how flat it was - the cephalic index was at 102% before

treatment. So far, we've seen wonderful results. At his last appointment

(right before Christmas), my son's cephalic index was 91%. He is six and a half

months old, so we're hoping the improvement continues.

>

> Prior to starting his treatment, I received a verbal approval from our

insurance company, Horizon Blue Cross Blue Shield of NJ. Unfortnately, I did

not ask for anything in writing, which in retrospect, was a huge mistake.

Yesterday, I received an explanation of benefits from the insurance company

showing that they denied coverage for the helmet, indicating that it was not

medically necessary. Before I start the whole appeal process, I wanted to know

if there is anyone out there who has been able to successfully appeal a denial

for a child whose problem is brachy, not plagio. Thanks!

>

>

> Kittery, ME

>

[Guest guest]

Thanks for the info - it will certainly be helpful to know if I have to move

forward with an appeal. I spoke with someone at our insurance company yesterday

and she said they have not received any of the clinician's notes and other

documentation regarding my son's condition even though it's been sent twice

already. I'm hoping once they receive and review the info, the decision will

change.

I'm happy that our progress has given you even more optimism. Though the first

few weeks were tough on us (me more so than him), when I look at his head now, I

can definitely see that it is worth it. Good luck!

> >

> > Hello all,

> >

> > In October, my son was fitted with a Hanger helmet. He had very mild plagio

- to be honest, I don't even remember the measurements for that, but since

beginning treatment, he has dropped into the normal range. Our main concern

with his head shape was how flat it was - the cephalic index was at 102% before

treatment. So far, we've seen wonderful results. At his last appointment

(right before Christmas), my son's cephalic index was 91%. He is six and a half

months old, so we're hoping the improvement continues.

> >

> > Prior to starting his treatment, I received a verbal approval from our

insurance company, Horizon Blue Cross Blue Shield of NJ. Unfortnately, I did

not ask for anything in writing, which in retrospect, was a huge mistake.

Yesterday, I received an explanation of benefits from the insurance company

showing that they denied coverage for the helmet, indicating that it was not

medically necessary. Before I start the whole appeal process, I wanted to know

if there is anyone out there who has been able to successfully appeal a denial

for a child whose problem is brachy, not plagio. Thanks!

> >

> >

> > Kittery, ME

> >

>