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- Where are you? Did your dr write a letter of medical necessity? If the evaluting dr for the ins. didn't even know what the measurments meant - sounds like they don't have a qualified dr making those determinations. What "kind" of band are you looking at - is there a certain one that your insurance will cover?

Let me back up - does your ins. policy cover Durable Medical Equipment? If so, find out who your ins. covers. (DOC, Star, Hanger, Etc.) from there find out what they want to get approval. As you know time is of the essence. The sooner the band is on the better correction you can achieve. Worst case you may need to get the band yourself and fight for reimbursment later. I know other parents have had to do that.

HTH!

Jen and LuliRight Tort - Plagio - Hanger Band Grad - CA

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We had an EI evaluation (in California) done for my son because he has

torticollis and he did not qualify for services. He was 6.5 months old at

the time of the evaluation and the torticollis was not causing any

developmental delays. If he was having delays, EI would have covered

physical therapy treatment but they would not have covered the band. I

don't think I have heard of any EI programs covering the cost of a band,

only therapy.

Molly

California

Nicolas, 15 months, tort & plagio, STARband 4/25/06-9/12/06, Graduate!

, 3.75

, 7

Hi, new and need help

Hi all,

My name is Pearce. My son Connor just turned 1, 9.5 months adjusted

age. He was diagnosed with palgiocephally in July. We have been fighting

with our insurance company since than to cover the starband. On October 31

it was denied stating it was not a medical necessity. When I called to ask

about it I was told that it's because the doctor who did the review said he

did not understand what the head measurements meant. They said that they

needed written documentation on how the measurements were taken. I also made

the mistake of telling the orthotist that we would be moving by Dec. 15.

They told me to wait and restart the process up there as the fee includes

the remolding. Well, we are still here and no longer have a buyer on our

house. My ped was supposed to appeal, emailed him yesterday to see where

that is at. Is there anything else I can do? Can I appeal myself? Any

help is greatly appreciated. Also, my son has torticollis, which we think

is how he developed the flat head. He has an EI eval next week. I was going

to see if there is a way for them to help pay for it. Has anyone tried

that?

Pearce

For more plagio info

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thanks everyone. I spoke with our orthotist today. he said he has

worked with EI before and has parents who had EI pay for it. The eval is next week, so I'm going to wait till than and see what they say before making an appointment.My dr. has sent 2 letters of medical necessity. I'm going to have my chiropractor write one as well. I have copies of all documents sent. I am sooooo glad I found this group, now I know what I can do. Yes, my insurance does cover durable medical equipment..I have a 10% copay. This entire process began because the place where we are getting the starband is out of network. I was simply trying to get the PLACE covered In-network ( I know they do this because my NICU docs were out of network and they covered them because I had no other choice but to use them). In the process I was given a long list of places within 30 miles of my home that were in-network. I called every single one of them and none did corrective helmets...only protective. Somehow in the mess they decided I needed the device pre-authorized. So, after this finally gets approved, I may have to fight to approve the out-of-network provider.

Ugh...insurance companies just suck! PearceBeacon, NYOn 1/16/07, JenandLuli@...

<JenandLuli@...> wrote:

- Where are you? Did your dr write a letter of medical necessity? If the evaluting dr for the ins. didn't even know what the measurments meant - sounds like they don't have a qualified dr making those determinations. What " kind " of band are you looking at - is there a certain one that your insurance will cover?

Let me back up - does your ins. policy cover Durable Medical Equipment? If so, find out who your ins. covers. (DOC, Star, Hanger, Etc.) from there find out what they want to get approval. As you know time is of the essence. The sooner the band is on the better correction you can achieve. Worst case you may need to get the band yourself and fight for reimbursment later. I know other parents have had to do that.

HTH!

Jen and LuliRight Tort - Plagio - Hanger Band Grad - CA

-- Pearce

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