Guest guest Posted July 21, 2005 Report Share Posted July 21, 2005 Hi! First, a little background... I am a newbie, my little is a little over five months old and my concern and questions about his sleep position, head shape, etc. were ignored for 4 1/2 months by his first ped. After his 4 month checkup I went to a different ped and told her that has torticollis and asked for referrals to the PT and neurologist. She confirmed that he has tort and that was three weeks ago. We have been fighting since then to get what he needs. We have been to the PT twice and have been doing the exercises. I have tried repositioning since he was about a month old. A visit to the neuro on Tues confirmed he had positional plagio and needs the DOC band. Paperwork went in yesterday to our insurance, HealthNet HMO, and we are now waiting with our fingers crossed. In anticipation of the insurance company's denial, I came across Doris' book " Slingshot " and an excerpt in my google search. I am wondering if any of you read it and whether you found it useful. I am hoping to find someone who lives in the SD area and had experiences (good or bad) with either Cranial Technology (CT) or SCOPe since I was initially given a Rx to SCOPe by the Neurosurgeon b/c according to him, our insurance is more receptive to SCOPe. However, a followup visit to our current ped revealed that she had patients with BAD experiences with SCOPe and had to have a second band done at CT. Needless to say, we do not want to put our poor baby through more than absolutely necessary. We are prepared to pay for the band if that is what it takes but would really like the insurance to pay for at least part of it. Since CT is out of network, we would have to pay $750 even if the insurance decides to approve our request and pays for the band in full which is the max allowable of $2250! Lastly, we are so angry and sad that the diagnosis came so late and only after I walked in insistent that something was wrong and needed to be remedied. I am angry at myself for not being more persistent when was younger. Perhaps starting the stretching exercises and PT earlier would have lessened the plagio. Have any of you took legal action again your ped? What were your experiences? Thanks for listening and I am grateful to have found you. Kellie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 21, 2005 Report Share Posted July 21, 2005 Hi! First, a little background... I am a newbie, my little is a little over five months old and my concern and questions about his sleep position, head shape, etc. were ignored for 4 1/2 months by his first ped. After his 4 month checkup I went to a different ped and told her that has torticollis and asked for referrals to the PT and neurologist. She confirmed that he has tort and that was three weeks ago. We have been fighting since then to get what he needs. We have been to the PT twice and have been doing the exercises. I have tried repositioning since he was about a month old. A visit to the neuro on Tues confirmed he had positional plagio and needs the DOC band. Paperwork went in yesterday to our insurance, HealthNet HMO, and we are now waiting with our fingers crossed. In anticipation of the insurance company's denial, I came across Doris' book " Slingshot " and an excerpt in my google search. I am wondering if any of you read it and whether you found it useful. I am hoping to find someone who lives in the SD area and had experiences (good or bad) with either Cranial Technology (CT) or SCOPe since I was initially given a Rx to SCOPe by the Neurosurgeon b/c according to him, our insurance is more receptive to SCOPe. However, a followup visit to our current ped revealed that she had patients with BAD experiences with SCOPe and had to have a second band done at CT. Needless to say, we do not want to put our poor baby through more than absolutely necessary. We are prepared to pay for the band if that is what it takes but would really like the insurance to pay for at least part of it. Since CT is out of network, we would have to pay $750 even if the insurance decides to approve our request and pays for the band in full which is the max allowable of $2250! Lastly, we are so angry and sad that the diagnosis came so late and only after I walked in insistent that something was wrong and needed to be remedied. I am angry at myself for not being more persistent when was younger. Perhaps starting the stretching exercises and PT earlier would have lessened the plagio. Have any of you took legal action again your ped? What were your experiences? Thanks for listening and I am grateful to have found you. Kellie Quote Link to comment Share on other sites More sharing options...
Guest AMYK Posted August 15, 2013 Report Share Posted August 15, 2013 Hi Kellie, I am a medical biller and I would advise you to read your insurance policy carefully. ( I know, I know it is tedious) but you will need to identify if your plan covers the S1040 ( the code for either a SCOPe or DOC band) for positional plagiocephaly. MOST plans cover the S1040 if used post-surgically, but in your it is not psot-surgical. You need to see if your plan " specifically excludes" helmets/bands for positional plagiocephaly, if they do - you are pretty much sunk- if they do allow for this service, you must read their medical policy on helmets/bands and make sure your baby meets their criteria for coverage. Good luck ! Amy K. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.