Re: Just casted...any info on UHC ?

September 13, 2004

Dee,

I'm sorry you have so much to deal with on top of just trying to get

help for your son! We have many members who did navigate the

insurance waters successfully, so I know you will get some help as

far as how to proceed with insurance coverage. Usually board posts

are slow on the weekends, but pick up quite a bit during the week,

so you should get a lot more replies over the next couple of days.

The CAPPSkids website has a good one page primer on how to proceed

with insurance. If you haven't been there yet, here's the link:

http://www.cappskids.org/PlagioInsuranceHelp.htm

Regarding UHC, I checked our site here for any helpful resources and

info. There are a couple of appeal/letter samples in the

files/insurance sections specifically about UHC, so that might be

helpful to check out. Even though the two examples are both UHC,

they got different reasons for denial (one for orthotics exclusion,

and one for not medically necessary.) Do you know the exact

language for band coverage in your policy? There is an insurance

code for each type of device/procedure. The code for Cranial

Orthoses is under Durable Medical Equipment and is " S1040. " This is

a new code as of 2002. Maybe you could call your insurance customer

service with the code info and get specific coverage information. If

you find your insurance company requests measurements, tell the

ortho at OPA that you need these measurements. If your son has

already been casted, they should be able to get these right off of

the 3D impression of your baby's head from the casting, right? My

knowledge is pretty limited, but can you get a copy of the pre-

authorization from your insurance company faxed, and can you get

your ped to write a letter of medical necessity? There are also

samples of letters of medical necessity in the files/insurance

section of the group, too.

I may be mistaken about the OPA location, but I was under the

impression that they have an insurance help packet that is passed

out to everyone. Did you receive a packet and was it helpful? Here

is a link to the Cranial Tech website explaining how their patient

coordinators should work with you to confirm pre-authorization and

obtaining a letter of medical necessity; did you receive this help?:

http://www.cranialtech.com/Treatment/getStarted.html

http://www.cranialtech.com/clinic_svc/insurance.html

Print them out and take them to your next appt. if you didn't get

this service.

From what I understand, Cranial tech may or may not take

measurements with calipers and such to get a numerical

representation of asymmetries at certain points on the head and

face, etc. Because improvement and rounding takes place 3

dimensionally all over the head and face at an infinite number of

points, anthropometric measurements will only provide a small

snapshot of what is actually going on with a head shape as it

corrects. I have heard that the 3D impression of the cast is

brought out for comparison at visits, and such, to provide a real,

3D picture of how the entire headshape has improved. Quantification

of improvement numerically, however, does carry tremendous weight

with insurance companies, and the industry is recognizing this.

Several companies have 3d imaging and scanning technology patented

to help with this quantification (Hanger has the Insignia Scanning

system, Orthomerica has the Starscanner, and Cranial Tech has a 3D

imaging system developed, but not yet rolled out to the facilities,

yet.) Until then, you shouldn't feel slighted that measurements

weren't taken, as is isn't the norm just yet, and make a request of

the ortho that they be taken.

I was disappointed for you to hear that you felt your orthos there

lacked experience and compassion for your situation. I am hoping

that you will get a refreshed response to your concerns and

questions at your son's fitting. Cranial Tech as well as the

DOCband maintain a stellar reputation for service and results, and I

fervently hope they step up and do not disappoint at your next appt.

I don't know if this info helped much, as I didn't personally have

experience with insurance (we used repositioning only,) but I just

wanted to get you started with some info.

Take care,

Christie (Mom to Repo'd Remy)

--- In Plagiocephaly , " dragana_g " <dragana_g@y...>

wrote:

>

> We decided to go ahead and have our son's head casted Friday 9/10

> with out insurance approval... he is 4 months 3 weeks old.. he was

> diganosed by our ped. at his 4 month check up...after I had told

> them he

> seemed to favor only sleeping on one side and his head was a little

> crooked...anyways.. I called the insurance company everyday to

> figure out what was needed to be done as well as the company that

> carries the DOC band (OPA -Houston, TX)..it was quite fustrating...

> all I could get from United is that if he needs it to go ahead and

> proceed... I said I didn't want them to deny me after the fact and

> they said they wouldn't do that... Has anyone had any experience

> with them. Also, when we went to OPA the company that is doing the

> casting for my son (DOC Band) they seemed to care more about

getting

> there money then helping a parent with their insurance....and when

> we went in to get him casted I asked for an evaluation first...all

> they did is ask a couple of questions and took a few digtal

pictures

> and proceeded to casting... I thought the process would be a little

> more scientific? I was expecting to get measurements that we could

> gauge his progress before and after... all the informantion I got

> was that he was severe and he would definetly need two bands... I'm

> paying out of pocket for the first band and waiting for the

> insurance to get back and I'm very upset... and I feel like the

> people at OPA lack experience/compassion.....

>

> Extremly upset

> Dee

> Houston, TX

September 13, 2004

Dee,

I think Christie did a great job with her reply so I will just

say... I have UHC and was told first by them that they wouldn't cover

it, because it was cosmetic (uh huh, sure it is). I proceeded anyway,

as my son was quite severe and I felt every day w/o was a day wasted.

After we received his helmet, and he had been wearing it for 2.5

months I got a letter in the mail from UHC that they were going to

pay, and paid it at 80%.

I checked often on myuhc.com for the claim info, and then it finally

showed up. Don't worry too much.... did you happen to write down the

persons name that said they wouldnt deny you?

Hope it works out in your favor... just keep checking on it.

Kim

mom to Kaela (9) and Jaxson 14 mo tort resolved, craniocap grad,

hypotonia, brachial plexus and brain cyst midline.