Letter of medical necessity

[Guest guest]

Liz and Tammy:

Following is our letter of medical necessity. I am sorry this took so long.

We are having major computer problems and I just decided to type it in and

send it this way. Hope this isn't too late. Please note that we are

getting the DOC band, so there is language specific to that end.

Sue

Letter of Medical Necessity

Re: Luck

To Whom It May Concern:

I am writing on behalf of the above named patient for whom we are requesting

orthotic correction of his cranial malformation of non-synostotic origin.

is a child with a skull deformity as a result of a number of

complicating factors. These have included that is one of twin who

suffered twin-to-twin syndrome, requiring C-section because of tachycardia,

prematurity at 29 weeks, postpartum requiring intubation and NICU care for

six weeks for management of airway, hydronephrosis, anemia and hypertension.

Because of early birth and supine positioning throughout this care this has

resulted in deformational forces on a prematurely developed calvarial vault.

Moreover, this has been compounded by right side torticollis and appropriate

positioning to avoid sudden infant death as recommended by the American

Academy of Pediatricians. These factors have resulted in an obvious cranial

vault asymmetrical deformity characterized as a parallelogram with right

occipital flattening, right frontal prominence and anterior positioning of

the right ear.

Attempts to positionally correct this without more aggressive intervention

has been limited. Because of this, is a candidate for non-surgical

molding therapy. While there are some centers that may correct this type of

positional deformity with surgery, the surgery is not without significant

risks and associated costs. The medical literature currently supports the

use of a non-operative, non-invasive correction of this condition through

use of dynamic orthodic cranioplasty. This involves correction of the

abnormal head shape with external forces. We feel that in 's case

the deformity is significant enough and that he is an appropriate age for

head molding to help improve the asymmetric deformity. The results of

dynamic orthodic cranioplasty typically show good improvement and there are

certainly many children who have near complete improvement. The success

correlates with the age at the beginning of treatment and with the severity

of the deformity. It is important that the treatment be started early

enough in development to take advantage of the flexibility of the infant's

skull. Beyond a certain age, external molding will not be possible and

surgery is the only alternative if the deformity remains significant.

It makes the most sense, from and economic and risk standpoint, to correct

these problems when they are easily corrected non-invasively rather than to

either leave them uncorrected and suffer natural consequences or to offer a

surgical solution that adds expense and risk. It is on this basis that a

treatment approach which involves dynamic cranioplasty is medically

indicated in cases like these.

We will continue to follow throughout the course of his treatment.

If further information is needed, please contact us directly.

Sincerely,

Pravin K. Patel, M.D.

Attending Plastic and Reconstructive Surgeon

Director, Cleft-Craniofacial Team

----- Original Message -----

From: yeeman <yeeman@...>

<Plagiocephalyegroups>

Sent: Sunday, May 21, 2000 7:11 PM

Subject: Re: Postural Therapies

> Me too, Liz.

> -----Original Message-----

> From: bailykuhn@... <bailykuhn@...>

> Plagiocephalyegroups <Plagiocephalyegroups>

> Date: Sunday, May 21, 2000 1:03 PM

> Subject: Re: Postural Therapies

>

>

> >Sue, I would love to see your letter.

> >

> >Tammy & 12/8/99

> >

> >

> >

> >

> ><< made sure our dr included in his letter all of the conditions that

> >. (I cheated and printed out the post with the combined list of

> >symptoms created for the poll and identified 11 out of 41 that

> > had.) The letter of medical necessity is very convincing. If

> >anyone is interested, I can post it.

> >

> > Any parent just starting the process might want to get their dr to

> write

> >this letter up front so the insurance company has something to review

> before

> >it sends out that first rejection letter.

> >

> > Sue >>

> >

> >

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