Insurance coverage for baby with severe brachy

[Guest guest]

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