Re: Insurance Policy Wording, re: band coverage

[Guest guest]

Looks close to BC of CA/s policy, if not exact.

http://medpolicy.bluecrossca.com/policies/OR-PR/cranial_orthosis.html

Interesting about the Brachy. We were never told that Ben had

brachy in addition to plagio. Guess it doesn't matter.

Amy

Mom to Ben

--- In Plagiocephaly , " redlocks2003 " <clkline@b...>

wrote:

>

>

> Hi,

>

> Here is an example of the increasingly detailed wording insurance

policies may have regarding when bands are or are not covered, as

shown by Healthlink's updated band coverage policy from this month:

>

> http://www.healthlink.com/provider/medpolicy/policies/OR-

PR/cranial_orthosis.html

>

>

> Take care,

>

> Christie (Mom to Repo'd Remy)

>

[Guest guest]

Looks close to BC of CA/s policy, if not exact.

http://medpolicy.bluecrossca.com/policies/OR-PR/cranial_orthosis.html

Interesting about the Brachy. We were never told that Ben had

brachy in addition to plagio. Guess it doesn't matter.

Amy

Mom to Ben

--- In Plagiocephaly , " redlocks2003 " <clkline@b...>

wrote:

>

>

> Hi,

>

> Here is an example of the increasingly detailed wording insurance

policies may have regarding when bands are or are not covered, as

shown by Healthlink's updated band coverage policy from this month:

>

> http://www.healthlink.com/provider/medpolicy/policies/OR-

PR/cranial_orthosis.html

>

>

> Take care,

>

> Christie (Mom to Repo'd Remy)

>

[Guest guest]

Thanks for the info. Christie. Very Interesting, I am floored that

they will not cover Brachy, that is just pure ignorance. It is just a

shame that money is always more important to these companies than the

well being of children.

CAROLG

--- In Plagiocephaly , " redlocks2003 " <clkline@b...>

wrote:

>

>

> Hi,

>

> Here is an example of the increasingly detailed wording insurance

policies may have regarding when bands are or are not covered, as

shown by Healthlink's updated band coverage policy from this month:

>

> http://www.healthlink.com/provider/medpolicy/policies/OR-

PR/cranial_orthosis.html

>

> Insurance may now be familiar with the " reconstructive " argument

parents present when insisting that banding does not provide cosmetic

improvement, but rather, correction to the norm. In that vein, they

are now presenting quite specific requirements for qualifying for

band coverage. These more detailed policies are a mixed bag of a

clearer understanding of plagio treatment, and continued ignorance on

some fronts. Some examples in the updated Healthlink policy include:

>

> required trial of 2 months repositioning efforts and/or pt, with an

exception if the baby is over 6 months old it is recognized that repo

is not a viable option as the baby is very mobile

>

> over 3 months of age, but up to 18 month of age okay

>

> any one of the following asymmetry severity threshholds met: skull

base 6mm, cranial vault 8mm, orbitiotragial 4mm.

>

> Second band may be required and is covered if above requirements

are met.

>

> Brachycephaly does not qualify, as asymmetries are not present, and

it's just a shorter head (!)

>

> It's clear that parents trying repo benefit from documenting that

effort by any means possible, through photographs, purchase receipts,

etc., so that proof of repo effort is there, if you ultimately decide

to go the band route.

>

> Staying abreast of trends in band coverage wording may be a help in

developing appropriate denial appeals. I've added this link to the

Links/Insurance/Policy links folder as well.

>

> Take care,

>

> Christie (Mom to Repo'd Remy)

>

[Guest guest]

Thanks for the info. Christie. Very Interesting, I am floored that

they will not cover Brachy, that is just pure ignorance. It is just a

shame that money is always more important to these companies than the

well being of children.

CAROLG

--- In Plagiocephaly , " redlocks2003 " <clkline@b...>

wrote:

>

>

> Hi,

>

> Here is an example of the increasingly detailed wording insurance

policies may have regarding when bands are or are not covered, as

shown by Healthlink's updated band coverage policy from this month:

>

> http://www.healthlink.com/provider/medpolicy/policies/OR-

PR/cranial_orthosis.html

>

> Insurance may now be familiar with the " reconstructive " argument

parents present when insisting that banding does not provide cosmetic

improvement, but rather, correction to the norm. In that vein, they

are now presenting quite specific requirements for qualifying for

band coverage. These more detailed policies are a mixed bag of a

clearer understanding of plagio treatment, and continued ignorance on

some fronts. Some examples in the updated Healthlink policy include:

>

> required trial of 2 months repositioning efforts and/or pt, with an

exception if the baby is over 6 months old it is recognized that repo

is not a viable option as the baby is very mobile

>

> over 3 months of age, but up to 18 month of age okay

>

> any one of the following asymmetry severity threshholds met: skull

base 6mm, cranial vault 8mm, orbitiotragial 4mm.

>

> Second band may be required and is covered if above requirements

are met.

>

> Brachycephaly does not qualify, as asymmetries are not present, and

it's just a shorter head (!)

>

> It's clear that parents trying repo benefit from documenting that

effort by any means possible, through photographs, purchase receipts,

etc., so that proof of repo effort is there, if you ultimately decide

to go the band route.

>

> Staying abreast of trends in band coverage wording may be a help in

developing appropriate denial appeals. I've added this link to the

Links/Insurance/Policy links folder as well.

>

> Take care,

>

> Christie (Mom to Repo'd Remy)

>