Re: Newly diagnosed and concerned

[Guest guest]

I don't know how to read the Star Scan measurements myself, but they would have

told you if the helmet wasn't necessary. Follow your gut. You know if your son's

head doesn't look right, so don't let someone talk you into feeling silly or

overly concerned. Also, I wouldn't just accept the insurance's " no " - not that

it sounds like that's what you're doing. Keep fighting for it and there is a

good chance you'll win. Ask them exactly why they won't cover it, and try to do

everything in writing. Print/save your correspondence so you have a record of

everything they say. Use email with them if possible instead of calling them. I

found that my insurance company's representatives contradicted each other and

was able to use that to get paid.

If you want to tell us more about your insurer, someone on the board might have

worked with them and be able to better help you.

Be persistent, and keep us all posted. We're on your side!

>

> My 7 month old son, Antwan was diagnosed May 12 with plagiocephaly. I was told

by the specialist at the plastic surgeon's office that my son's insurance will

most likely not cover the starband. Today i spoke with someone at cranial tech

and after she spoke with their insurance specialist, she said the same thing-

it's not covered. The star band costs almost $2700 and from what i've read the

DOC at cranial tech costs about $1000 more. I've been talking to people at the

insurance company and i'm already getting conflicting information about

coverage. I did ask the ped to get things started to see what happens but i'm

already frustrated.

> i've been losing sleep over it lately and my bf thinks it's natural and i'm

over reacting. Sooo, I thought maybe if i posted his measurements from the

StarScan, someone out there could tell me what they think of the severity.

>

> cephalic ratio: 0.920

> anterior symmetry ratio: 0.773

> posterior symmetry ratio: 0.672

> ear offset 12.1mm

> cranial vault asymmetry index: 4.0

>

[Guest guest]

I think he does need a band. Our specialist recommends banding at 90% or above

for brachycephaly (flat in back with extra width). Your number it 92%. My

daughter had brachy, but more severe, and a little asymmetry. I'm don't remember

what her symmetry ratios were, but she was off by 4.5 mm to start (the

difference between the 2 diagonals). Give the 12mm of ear offset, I think your

son's asymmetry must be higher. So I recommend banding, even if you have to pay.

We were very lucky that our starband was covered. Even if they refuse to pay you

can appeal the decision and possibly be reimbursed.

-christine

sydney, 4 yrs, starband grad

>

> My 7 month old son, Antwan was diagnosed May 12 with plagiocephaly. I was told

by the specialist at the plastic surgeon's office that my son's insurance will

most likely not cover the starband. Today i spoke with someone at cranial tech

and after she spoke with their insurance specialist, she said the same thing-

it's not covered. The star band costs almost $2700 and from what i've read the

DOC at cranial tech costs about $1000 more. I've been talking to people at the

insurance company and i'm already getting conflicting information about

coverage. I did ask the ped to get things started to see what happens but i'm

already frustrated.

> i've been losing sleep over it lately and my bf thinks it's natural and i'm

over reacting. Sooo, I thought maybe if i posted his measurements from the

StarScan, someone out there could tell me what they think of the severity.

>

> cephalic ratio: 0.920

> anterior symmetry ratio: 0.773

> posterior symmetry ratio: 0.672

> ear offset 12.1mm

> cranial vault asymmetry index: 4.0

>

[Guest guest]

Well they did tell me that Antwan needs the band but i was just trying to figure

out how severe it really is, from someone other than a plastic surgeon. I

believe he needs it so i def plan to fight it out with the insurance company. He

has universal ufirst through florida's medicaid reform in broward county. Both

the plastic surgeon and cranial tech said that it was a fairly new HMO and they

don't have much experience with them but they do know they haven't had much

luck. I was thinking that if universal does deny him, i could change his

provider under medicaid's 'good cause' rule for not being able to provide the

health care he needs. I was planning on calling some of the other providers to

see if they would cover it, figure it cant hurt really. I sadly cannot afford to

pay out of pocket and wait for reimbursement and cannot get approved for care

credit. I just hope that we can get this all figure out before its too late.

It's really a shame that i couldn't get the referral they needed sooner but the

PED insisted it would resolve with repo even though it didn't for my daughter.

She's now 18 months and i was told she wouldn't benefit from the star band.

> >

> > My 7 month old son, Antwan was diagnosed May 12 with plagiocephaly. I was

told by the specialist at the plastic surgeon's office that my son's insurance

will most likely not cover the starband. Today i spoke with someone at cranial

tech and after she spoke with their insurance specialist, she said the same

thing- it's not covered. The star band costs almost $2700 and from what i've

read the DOC at cranial tech costs about $1000 more. I've been talking to people

at the insurance company and i'm already getting conflicting information about

coverage. I did ask the ped to get things started to see what happens but i'm

already frustrated.

> > i've been losing sleep over it lately and my bf thinks it's natural and i'm

over reacting. Sooo, I thought maybe if i posted his measurements from the

StarScan, someone out there could tell me what they think of the severity.

> >

> > cephalic ratio: 0.920

> > anterior symmetry ratio: 0.773

> > posterior symmetry ratio: 0.672

> > ear offset 12.1mm

> > cranial vault asymmetry index: 4.0

> >

>

[Guest guest]

I think calling around is a very good idea. Maybe you'll get lucky. I wish I

could help you more, but I just don't know much about Medicaid plans. You may

want to look around the internet and educate yourself on some of the arguments

others have used with their insurance companies. This site has a lot of

resources in the " Files " section. Make sure to read the " 1st Step for Insurance "

file. It literally has step-by-step directions on what to do.

Plagiocephaly/files/Insurance%20Help/Genera\

l%20Appeal%20Info/

Good luck and keep us posted!

> > >

> > > My 7 month old son, Antwan was diagnosed May 12 with plagiocephaly. I was

told by the specialist at the plastic surgeon's office that my son's insurance

will most likely not cover the starband. Today i spoke with someone at cranial

tech and after she spoke with their insurance specialist, she said the same

thing- it's not covered. The star band costs almost $2700 and from what i've

read the DOC at cranial tech costs about $1000 more. I've been talking to people

at the insurance company and i'm already getting conflicting information about

coverage. I did ask the ped to get things started to see what happens but i'm

already frustrated.

> > > i've been losing sleep over it lately and my bf thinks it's natural and

i'm over reacting. Sooo, I thought maybe if i posted his measurements from the

StarScan, someone out there could tell me what they think of the severity.

> > >

> > > cephalic ratio: 0.920

> > > anterior symmetry ratio: 0.773

> > > posterior symmetry ratio: 0.672

> > > ear offset 12.1mm

> > > cranial vault asymmetry index: 4.0

> > >

> >

>

[Guest guest]

I know that they like to see the symmetry ratios in the 90's and the cranial vault below 3 so this is also a case that could probably use some plagio help as well.

Re: Newly diagnosed and concerned

I think he does need a band. Our specialist recommends banding at 90% or above for brachycephaly (flat in back with extra width). Your number it 92%. My daughter had brachy, but more severe, and a little asymmetry. I'm don't remember what her symmetry ratios were, but she was off by 4.5 mm to start (the difference between the 2 diagonals). Give the 12mm of ear offset, I think your son's asymmetry must be higher. So I recommend banding, even if you have to pay. We were very lucky that our starband was covered. Even if they refuse to pay you can appeal the decision and possibly be reimbursed.-christinesydney, 4 yrs, starband grad>> My 7 month old son, Antwan was diagnosed May 12 with plagiocephaly. I was told by the specialist at the plastic surgeon's office that my son's insurance will most likely not cover the starband. Today i spoke with someone at cranial tech and after she spoke with their insurance specialist, she said the same thing- it's not covered. The star band costs almost $2700 and from what i've read the DOC at cranial tech costs about $1000 more. I've been talking to people at the insurance company and i'm already getting conflicting information about coverage. I did ask the ped to get things started to see what happens but i'm already frustrated.> i've been losing sleep over it lately and my bf thinks it's natural and i'm over reacting. Sooo, I thought maybe if i posted his measurements from the StarScan, someone out there could tell me what they think of the severity.> > cephalic ratio: 0.920> anterior symmetry ratio: 0.773> posterior symmetry ratio: 0.672> ear offset 12.1mm> cranial vault asymmetry index: 4.0>

[Guest guest]

Thanks for the help ladies. I know he could benefit from being banded so i just

have my fingers crossed he is approved!

>

> My 7 month old son, Antwan was diagnosed May 12 with plagiocephaly. I was told

by the specialist at the plastic surgeon's office that my son's insurance will

most likely not cover the starband. Today i spoke with someone at cranial tech

and after she spoke with their insurance specialist, she said the same thing-

it's not covered. The star band costs almost $2700 and from what i've read the

DOC at cranial tech costs about $1000 more. I've been talking to people at the

insurance company and i'm already getting conflicting information about

coverage. I did ask the ped to get things started to see what happens but i'm

already frustrated.

> i've been losing sleep over it lately and my bf thinks it's natural and i'm

over reacting. Sooo, I thought maybe if i posted his measurements from the

StarScan, someone out there could tell me what they think of the severity.

>

> cephalic ratio: 0.920

> anterior symmetry ratio: 0.773

> posterior symmetry ratio: 0.672

> ear offset 12.1mm

> cranial vault asymmetry index: 4.0

>