Guest guest Posted October 1, 2004 Report Share Posted October 1, 2004 My son is 11 1/2 months old, and he has positional plagiocephaly. It has gotten progressively better since we first realized he had it at about 6 weeks old. However, it is not completely better. His head is almost perfectly round, but when you look directly down, his ears are still a tad off. I look at some of the pics on plagio Web sites, and his is not near what these children's heads are. However, we're still concerned, and I'm wondering if anyone has had luck getting insurance to pay for this. If it were obvious, of course, I wouldn't even question whether to do it or not. But it's not obvious, and it has improved so much that I wonder whether it really will even out on its own. Oh, and the mom asking if she was too late: My neurologist said that while it is definitely easier to fix early on, he has seen children as old as 5 years old have success with corrective therapy. He didn't even bat an eye at waiting until my son was a year old to determine whether or not to even consider intervention. And I have even seen improvement within the past three months, or from 9 months of age until almost a year old. Anyway, I'm wondering if I'm going to have more trouble getting insurance to help out since his IS NOT noticeable, thus may be considered more of a cosmetic thing. Opinions, please! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2004 Report Share Posted October 1, 2004 We have an insurance database where you can see if your insurance is listed and what was paid. Usually they do go by measurements to determine coverage but every policy is different. As to what your Dr said, I don't know what treatment is available to a child over 2 for plagio besides very invasive skull surgery. As a rule, the younger the child obtaining band/helmet treatment, the better the outcome. Natasha Atlanta, GA > My son is 11 1/2 months old, and he has positional plagiocephaly. It > has gotten progressively better since we first realized he had it at > about 6 weeks old. However, it is not completely better. His head is > almost perfectly round, but when you look directly down, his ears are > still a tad off. I look at some of the pics on plagio Web sites, and > his is not near what these children's heads are. However, we're still > concerned, and I'm wondering if anyone has had luck getting insurance > to pay for this. If it were obvious, of course, I wouldn't even > question whether to do it or not. But it's not obvious, and it has > improved so much that I wonder whether it really will even out on its > own. > Oh, and the mom asking if she was too late: My neurologist said that > while it is definitely easier to fix early on, he has seen children > as old as 5 years old have success with corrective therapy. He didn't > even bat an eye at waiting until my son was a year old to determine > whether or not to even consider intervention. And I have even seen > improvement within the past three months, or from 9 months of age > until almost a year old. > Anyway, I'm wondering if I'm going to have more trouble getting > insurance to help out since his IS NOT noticeable, thus may be > considered more of a cosmetic thing. Opinions, please! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 2, 2004 Report Share Posted October 2, 2004 Hi, Have you had your son evaluated by an orthotist facility to see if they feel he would see significant correction from a helmet or band? We do have some severity assessment forms here at the group that could help in evaluating your son; they are in the links/severity assessment of plagio folder. Insurance coverage varies from member to member; even if some get a denial, many proceed with the band and pay for it on their own while pursuing the appeals process. If you'd like a snapshot of insurance reimbursement, you can check out the Database section of the group for " Who's Insurance Paid What. " You may even find that someone in the group had your exact insurance. It's true some insurance cos have minimum asymmetry measurements required for coverage. Do you know what your son's measurements are? A consult with an ortho might help you get these measurements. There are some links to different insurance policies in the links/insurance/insurance policies folder if you'd like to take a look at them. In addition, some have maximum ages for coverage based on the insurance companies' opinion of how old is too old to get correction. Cranial Orthoses are coded " S1040 " usually Durable Medical Equipment, if you want to call your insurance and check on coverage. My thoughts on some of your post includes concern at your neuro's comment that he/she has seen success with corrective therapy up until 5 years of age... what is he/she referring to? Almost all helmets and bands are only FDA approved for treatment up to 18 months, and sometimes the DOCband can be used up until 24 months. After 2 years of age, only cranial vault surgery can be used. Other than that, you're really just hoping for natural rounding (there is no guarantee of this) or perhaps trying an alternative therapy such as craniosacral. Waiting until your son was a year is very late on the neuro's part to assess the banding option, but there is still time to band if you choose to explore this option. The American Academy of Pediatrics July 2003 release on Plagiocephaly clearly states that helmets/bands have the best response when used between 4 and 12 months of age. Have you been aggressively repositioning your son all this time? I was able to treat my daughter Remy's plagio/brachy with just repo only - we didn't band or helmet. We did set a deadline for trying repo, though, at 8 months of age. We wanted to make a decision on the banding option in a timely enough manner to be able to get good correction from a band while she was still young enough. We saw a dramatic improvement from 5 - 7 months, some rounding from 7 - 9 months, and a teeny bit of improvement from 9 - 11 months. Remy's progress pics are in the photos/before and after/repositioned/Remy folder if you are interested. It sounds as if you also have been seeing good improvement over time as well, but still have some doubts about his ears, etc. If I were you, owing to your son's advanced age, I would base my treatment decision on how his head looks right now, not how I think it might look in a few more months. Ultimately it's going to be your decision, but maybe it would help to get info about insurance coverage, severity assessment, and a consult with an orthotist to help with your decision. Where are you located? Christie (Mom to Repo'd Remy) -- In Plagiocephaly , " erin1mama2003 " <erin1mama2003@y...> wrote: > My son is 11 1/2 months old, and he has positional plagiocephaly. It > has gotten progressively better since we first realized he had it at > about 6 weeks old. However, it is not completely better. His head is > almost perfectly round, but when you look directly down, his ears are > still a tad off. I look at some of the pics on plagio Web sites, and > his is not near what these children's heads are. However, we're still > concerned, and I'm wondering if anyone has had luck getting insurance > to pay for this. If it were obvious, of course, I wouldn't even > question whether to do it or not. But it's not obvious, and it has > improved so much that I wonder whether it really will even out on its > own. > Oh, and the mom asking if she was too late: My neurologist said that > while it is definitely easier to fix early on, he has seen children > as old as 5 years old have success with corrective therapy. He didn't > even bat an eye at waiting until my son was a year old to determine > whether or not to even consider intervention. And I have even seen > improvement within the past three months, or from 9 months of age > until almost a year old. > Anyway, I'm wondering if I'm going to have more trouble getting > insurance to help out since his IS NOT noticeable, thus may be > considered more of a cosmetic thing. Opinions, please! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 2, 2004 Report Share Posted October 2, 2004 You've received some great advice. I too would call my insurance company ASAP and find out what their measurement criteria is. Also, the age limit, if any. My old insurance was only good for children ages 4-12 months. My new insurance for ages 4-8 months (which seems ridiculous). However, keep in mind that even if you've passed their age limit you may be able to appeal it. If you are concerned that repo won't give you the results you want, then I would proceed with an evaluation before he gets any older. Good Luck, Dianna Mom to DOC Band 9/13 plagio/brachy > > My son is 11 1/2 months old, and he has positional plagiocephaly. > It > > has gotten progressively better since we first realized he had it > at > > about 6 weeks old. However, it is not completely better. His head > is > > almost perfectly round, but when you look directly down, his ears > are > > still a tad off. I look at some of the pics on plagio Web sites, > and > > his is not near what these children's heads are. However, we're > still > > concerned, and I'm wondering if anyone has had luck getting > insurance > > to pay for this. If it were obvious, of course, I wouldn't even > > question whether to do it or not. But it's not obvious, and it has > > improved so much that I wonder whether it really will even out on > its > > own. > > Oh, and the mom asking if she was too late: My neurologist said > that > > while it is definitely easier to fix early on, he has seen > children > > as old as 5 years old have success with corrective therapy. He > didn't > > even bat an eye at waiting until my son was a year old to > determine > > whether or not to even consider intervention. And I have even seen > > improvement within the past three months, or from 9 months of age > > until almost a year old. > > Anyway, I'm wondering if I'm going to have more trouble getting > > insurance to help out since his IS NOT noticeable, thus may be > > considered more of a cosmetic thing. Opinions, please! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 5, 2004 Report Share Posted October 5, 2004 > > > My son is 11 1/2 months old, and he has positional > plagiocephaly. > > It > > > has gotten progressively better since we first realized he had > it > > at > > > about 6 weeks old. However, it is not completely better. His > head > > is > > > almost perfectly round, but when you look directly down, his > ears > > are > > > still a tad off. I look at some of the pics on plagio Web sites, > > and > > > his is not near what these children's heads are. However, we're > > still > > > concerned, and I'm wondering if anyone has had luck getting > > insurance > > > to pay for this. If it were obvious, of course, I wouldn't even > > > question whether to do it or not. But it's not obvious, and it > has > > > improved so much that I wonder whether it really will even out > on > > its > > > own. > > > Oh, and the mom asking if she was too late: My neurologist said > > that > > > while it is definitely easier to fix early on, he has seen > > children > > > as old as 5 years old have success with corrective therapy. He > > didn't > > > even bat an eye at waiting until my son was a year old to > > determine > > > whether or not to even consider intervention. And I have even > seen > > > improvement within the past three months, or from 9 months of > age > > > until almost a year old. > > > Anyway, I'm wondering if I'm going to have more trouble getting > > > insurance to help out since his IS NOT noticeable, thus may be > > > considered more of a cosmetic thing. Opinions, please! Quote Link to comment Share on other sites More sharing options...
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