Insurance Help

August 19, 2004

Hello,

Just got a letter from my insurance company yesterday (BCBS), and

they are asking if any repositioning had been tired prior to seeing

the cranio/facial Doctor…We did do this from 6weeks up to 5 months

(when he got helmet), but how should we word this so we cover all

bases? I am hoping that this will be last step in process to

approval of coverage.

Milan's mom 5 months old (CranioCap for Brachy)

August 19, 2004

,

Explain what you did to repo him from 5 wks to 5 months. Be

specific. You can view my appeal in the insurance help section under

exclusion appeal. If you can't find it I'll post more later.

> Hello,

>

> Just got a letter from my insurance company yesterday (BCBS), and

> they are asking if any repositioning had been tired prior to seeing

> the cranio/facial Doctor…We did do this from 6weeks up to 5 months

> (when he got helmet), but how should we word this so we cover all

> bases? I am hoping that this will be last step in process to

> approval of coverage.

>

> Milan's mom 5 months old (CranioCap for Brachy)

August 19, 2004

,

Here is the excerpt from our appeal ...

Birth to 2 Months:

Xxxxx has always been put to sleep on her back. We alternated her

position from birth. For example, we would alternate which side her

head would have to turn in her crib or bassinet to face the center of

the room. We limited swing, car seat, and bouncy seat time to less

than 4 hours a day. We began ¡§tummy time¡¨ exercises at about 4

weeks. We started with 1-2 minutes a few times each day. Prior to

her 2-month appointment we noticed her abnormal head shape. This is

when we looked at her early pictures and realized it had been like

this since birth. At Xxxxx¡¦s 2-month check-up I spoke with her

primary care physician. He said not to worry and to put her to sleep

on the non-flat side and give her as much ¡§tummy time¡¨ as possible.

We would re-evaluate at her 4-month check-up.

After doing a lot of research and following our doctor¡¦s advice we

began an aggressive repositioning effort. We made every attempt to

keep Xxxxx off of her flat side. We purchased positioners for her

crib and car seat. We used rolled up blankets under her shoulder,

limited her bouncy seat, car seat, and swing time to less than 2

hours a day whenever possible, and we increased ¡§tummy time¡¨

activities and use of a front carrier. We checked her sleeping

position numerous times each evening and during naps to insure she

was not resting on the flat spot.

3 Months:

After one month of aggressive repositioning in addition to the prior

2 months of normal repositioning we had not seen any improvements. I

consulted with Xxxxx¡¦s primary care physician again and obtained a

prescription for a range of motion evaluation to rule out any neck

involvement, which would make repositioning difficult. On September

9, 2003 we visited the Cranial Technologies clinic in Charlotte, NC

where they evaluated Xxxxx for neck involvement and plagiocephaly.

They determined that Xxxxx did have tightness in her right SCM and

moderate plagiocephaly. They took anthropometric measurements, which

indicated 11 mm of cranial vault asymmetry, 9 mm of ear asymmetry,

and 4 mm of orbital asymmetry. These copies of these measurements

and other supporting documentation can be found in section 5.

Upon reviewing the information from the orthotist, Xxxxx¡¦s primary

care physician wrote a prescription for DOC Band therapy and letter

of medical necessity. Copies of which can be found in section 5.

We have continued repositioning Xxxxx and started at home physical

therapy for her right SCM. There are numerous factors shown to

influence the development of plagiocephaly. In a number of

scientific articles, I have found the repeated mention of the

following precipitating factors (to only name a few): , , , ,

„h Premature Birth

„h Restrictive intrauterine environment

„h Birth Trauma

„h Congenital Muscular Torticollis

„h Cervical-Vertebral abnormalities

„h Sleep Position

.....

Here is a link to the whole letter ...

http://f6.grp.fs.com/v1/oOokQe9Y6PdCAqqlj4sTW_MHOX-

osKI4zXSvnTK5gX09bQEnrg9oXNlefhAzxkZpnu2oWok83ryzuMcGaWk/Insurance%

20Help/Contract%20Exclusion%20Appeal/generic%20appeal.doc

You'll have to copy and paste that link since it is so long.

Sorry I was short in the last reply. I had to go do something real

fast : )

I hope that helps.

mom to na

> > Hello,

> >

> > Just got a letter from my insurance company yesterday (BCBS), and

> > they are asking if any repositioning had been tired prior to

seeing

> > the cranio/facial Doctor¡KWe did do this from 6weeks up to 5

months

> > (when he got helmet), but how should we word this so we cover all

> > bases? I am hoping that this will be last step in process to

> > approval of coverage.

> >

> > Milan's mom 5 months old (CranioCap for Brachy)

August 19, 2004

,

This is perfect! Thank you SO much!

Milan's mom 5 months (Plagio/Brachy)

> > > Hello,

> > >

> > > Just got a letter from my insurance company yesterday (BCBS),

and

> > > they are asking if any repositioning had been tired prior to

> seeing

> > > the cranio/facial Doctor¡KWe did do this from 6weeks up to 5

> months

> > > (when he got helmet), but how should we word this so we cover

all

> > > bases? I am hoping that this will be last step in process to

> > > approval of coverage.

> > >

> > > Milan's mom 5 months old (CranioCap for Brachy)

September 26, 2005

Jill,

Thanks for your reply. My son and I have been ALOT. I have made some posts about all the road blocks we've had. Needless to say it seems like Massachusetts "specialists" really need to go back to medical school. I have one local Hanger the others would be quite a bit traveling. I did call that particular office and didn't like there answers to my questions. There just as uninformed of plagio and tort as the rest of Ma. Also my son is almost 10 mths old that would be considered too old for them. So since I would be traveling regardless I want to go to someone who knows what there doing and specializes in it- not just every so often. My son has enough issues he doesn't need anymore. My orthotist in Boston that made my son's molded pillow that started us on this road from hell was also suppose to know what he was doing and claimed "he done this a million times" screwed up the pillow god I'd hate to be the children he's fitting helmets for. The people from CT haven't really impressed me much on the personality level but hey they at least seem like they know what there talking about and have the experience so that was what made my choice for me. I also had looked into Starband but it wasn't local either and that brought me back to my CT reasonings. Like you said as well as many others- all for there own reasons. Everyone chooses what works for them best regardless of the company. And theres so much to factor in- its not one shoe fits all. I don't know how much insurance will cover yet, but I do know when I first called they called Hanger would be covered in full. As for now they claim they need to check the amount-if they can cover Hanger in full, they should cover CT in full IMO. I'm going for knowledge and experience. They should understand that. I just need to get my ducks in a row now. Sorry for babbling.

Soyscentials" Because it pays to light the way to a "soot free" future!"For a FREE votive go to www.Familysoycandles.com and enter my candle drawing

Re: Insurance Help

I think the only reason people say Doc Bands are "preferred" is because the orthotist is trained and works only with the bands at Cranial Tech. Though, that doesn't mean they are perfect. We are using a Starband, and our orthotist is very knowledgable, and he is the only one at that facility that does the bands...and he does many...so I would say that he is very experienced also. I'm sorry for any of you who may take this as being rude...but the other mom's who didn't choose CT will agree that the Doc Band isn't the only, nor is it always the "best" choice. It all depends on the orthotist. The Starband was covered in full for us, and is slightly closer. We could have chosen the Hanger facility here in our town...but it wasn't covered by insurance, and they also didn't seem to know as much about the bands. We are very happy with our choice...and after only 2 1/2 weeks, I have noticed great rounding in my 11 month old daughter that has severe plagio and tort.Jill> I'm now waiting for insurance so I can do my casting. When I called > my insurance-HCVM aka CCN I was told they only cover Hanger. Later > they said they would apply whatever they cover for Hanget to the DOC > band. I have been through sooo much just to get to this point I don't > want to chance getting a band from someone who doesn't know what there > doing. BUT they don't even know what there coverage for Hanger is so > I don't even know what I'm looking for a difference. BUT money is > VERY tight right now husbands been laid off. I need some great > documentation to why DOC Bands are preferred over others and what > other documentaion should I include?

September 26, 2005

Jill,

Thanks for your reply. My son and I have been ALOT. I have made some posts about all the road blocks we've had. Needless to say it seems like Massachusetts "specialists" really need to go back to medical school. I have one local Hanger the others would be quite a bit traveling. I did call that particular office and didn't like there answers to my questions. There just as uninformed of plagio and tort as the rest of Ma. Also my son is almost 10 mths old that would be considered too old for them. So since I would be traveling regardless I want to go to someone who knows what there doing and specializes in it- not just every so often. My son has enough issues he doesn't need anymore. My orthotist in Boston that made my son's molded pillow that started us on this road from hell was also suppose to know what he was doing and claimed "he done this a million times" screwed up the pillow god I'd hate to be the children he's fitting helmets for. The people from CT haven't really impressed me much on the personality level but hey they at least seem like they know what there talking about and have the experience so that was what made my choice for me. I also had looked into Starband but it wasn't local either and that brought me back to my CT reasonings. Like you said as well as many others- all for there own reasons. Everyone chooses what works for them best regardless of the company. And theres so much to factor in- its not one shoe fits all. I don't know how much insurance will cover yet, but I do know when I first called they called Hanger would be covered in full. As for now they claim they need to check the amount-if they can cover Hanger in full, they should cover CT in full IMO. I'm going for knowledge and experience. They should understand that. I just need to get my ducks in a row now. Sorry for babbling.

Soyscentials" Because it pays to light the way to a "soot free" future!"For a FREE votive go to www.Familysoycandles.com and enter my candle drawing

Re: Insurance Help

I think the only reason people say Doc Bands are "preferred" is because the orthotist is trained and works only with the bands at Cranial Tech. Though, that doesn't mean they are perfect. We are using a Starband, and our orthotist is very knowledgable, and he is the only one at that facility that does the bands...and he does many...so I would say that he is very experienced also. I'm sorry for any of you who may take this as being rude...but the other mom's who didn't choose CT will agree that the Doc Band isn't the only, nor is it always the "best" choice. It all depends on the orthotist. The Starband was covered in full for us, and is slightly closer. We could have chosen the Hanger facility here in our town...but it wasn't covered by insurance, and they also didn't seem to know as much about the bands. We are very happy with our choice...and after only 2 1/2 weeks, I have noticed great rounding in my 11 month old daughter that has severe plagio and tort.Jill> I'm now waiting for insurance so I can do my casting. When I called > my insurance-HCVM aka CCN I was told they only cover Hanger. Later > they said they would apply whatever they cover for Hanget to the DOC > band. I have been through sooo much just to get to this point I don't > want to chance getting a band from someone who doesn't know what there > doing. BUT they don't even know what there coverage for Hanger is so > I don't even know what I'm looking for a difference. BUT money is > VERY tight right now husbands been laid off. I need some great > documentation to why DOC Bands are preferred over others and what > other documentaion should I include?

September 26, 2005

I'm sorry for

> any of you who may take this as being rude...but the other mom's

who

> didn't choose CT will agree that the Doc Band isn't the only, nor

is

> it always the " best " choice. It all depends on the orthotist.

>

Jill,

Of course it depends upon the orthotist. And it sounds like you

have a great one! I'm very happy that your daughter is having such

great improvement with her STARband. I only wish that for every

child!

When I was a moderator on this board several years ago there were

many discussions about this. They often turned nasty. We would

hear horror stories about botched bands at least once a week. Some

of us would get angry that this continued to happen. Others would

get defensive. I don't think anyone is trying to hurt anyone else's

feelings. If you have success with a product you want to share it,

just as you are doing. People often get defensive. But we're not

rooting for football teams here. We all have the same goal of

getting correction for our children. I personally don't care what

product someone uses.

I'm a firm believer in checking everything out. I will always say

if someone is near a CT to get a free evaluation. All it requires

is your time. If new member is in your area I hope you would do the

same since you have such confidence in your orthotist.

When we decided to band our newest baby my insurance agent begged me

to look around at the in network providers. I did. I called

around. I was told by one there were no parental referrals he could

provide me with. Another orthotist told me his helmet was FDA

approved. When I asked for the 510k number he admitted that it

wasn't. When I told him we were getting a DOC consult he started

ripping CT up and down. He was horribly unprofessional and said I

would never find a happy DOC parent. After he finished I explained

that our 4 year son had a DOC Band and got pretty much 100%

correction. It was clear I was more knowledgeable on the topic than

he. So yes the DOC Band was the " best " product for us. I'm really

glad I checked out other places. Now I am armed with information to

assist me with getting in network coverage for the DOC Band.

The only reason I bring this up is to explain. We all want is best

for our children. We make different decisions based on what is best

for us. Nobody is trying to hurt anyone's feelings.

I hope your daughter continues getting great correction! She'll be

a graduate before you know it!

Mom to Dane (DOC Grad 02) and Cecelia (DOC 9/05)

September 26, 2005