Re: In need of guidance...

November 17, 2007

Did they give you a specific # of mm off?

There are industry standards or guidelines - Molly knows alot about that - and some ins. companies won't band under a certain #.

I do know that some parents go ahead an band and then fight with the ins later - because timing is of the essence.

Jen and Luli - 23 months

Left tort - Right Plagio - Hanger Band Grad - CA

http://www.babiesonline.com/babies/j/jens5th/

In need of guidance...

Hi. I am new to this group but already have learned so much from

reading all of your posts and the files. It has been very helpful. I

have a DD who just turned five months. She was referred to a PT for

torticollis and positional plagiocephaly at 4 mo. We began PT and

stretches at home right away for her torticollis and she is doing very

well with that. We went to Cranial Technologies to have her evaluated

for the DOC Band and they determined she was a moderate - high rating

of plagio and felt she would be a good candidate for the band. She

also has some assymetry with her ears and eyes. We decided to go

through with the band and started the approval process with our

insurance co. only to be denied. We have Humana PPO and they denied

it on the basis that they consider my daughters condition to be very

mild and the band to be unnecessary. I'm wondering how they can have

such different standards for need. We even had a letter of medical

necessity sent to them from my pediatrician. I've been struggling

with whether or not to band my daughter from the start because the

friends and family that Ive confided in have told me that I'm being

"nit-picky" and that she is fine. I've read all the info about what

untreated plagio and tort can lead to and I don't want that to happen.

I guess I'm looking for some suggestions on what to do about the

insurance and if they continue to deny our claim... do you still go

ahead with treatment and figure out how to pay for it later??? Or do

you wonder why they consider it to be mild when CT says its on the

high end of moderate??? I'm very confused and would appreciate any

suggestions or input. Thanks!

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November 18, 2007

I would explain the situation with the insurance company to your pediatrician, PT and CT. They can provide as much documentation as the company wants. There are samples of letters located under "files" that you can use if needed. In the meantime, go ahead and band her. If you have the money (I know it isn't just "laying around") available, it can't hurt anything. My daughter has been banded for two weeks and a day, and I can already see a difference. It is funny that your family says your are being "nit picky". My grandma still denies that there is a flat spot on my daughter. She is considered severe, and it is VERY obvious. Wichita, KScbukala13 <cbukala13@...> wrote: Hi. I am new to this group but already have learned so much fromreading all of your posts and the files. It has been very helpful. Ihave a DD who just turned five months. She was referred to a PT fortorticollis and positional plagiocephaly at 4 mo. We began PT andstretches at home right away for her torticollis and she is doing verywell with that. We went to Cranial Technologies to have her evaluatedfor the DOC Band and they determined she was a moderate - high ratingof plagio and felt she would be a good candidate for the band. Shealso has some assymetry with her ears and eyes. We decided to gothrough with the band and started the approval process with ourinsurance co. only to be denied. We have Humana PPO

and they deniedit on the basis that they consider my daughters condition to be verymild and the band to be unnecessary. I'm wondering how they can havesuch different standards for need. We even had a letter of medicalnecessity sent to them from my pediatrician. I've been strugglingwith whether or not to band my daughter from the start because thefriends and family that Ive confided in have told me that I'm being"nit-picky" and that she is fine. I've read all the info about whatuntreated plagio and tort can lead to and I don't want that to happen.I guess I'm looking for some suggestions on what to do about theinsurance and if they continue to deny our claim... do you still goahead with treatment and figure out how to pay for it later??? Or doyou wonder why they consider it to be mild when CT says its on thehigh end of moderate??? I'm very confused and would appreciate anysuggestions or input.

Thanks!

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November 18, 2007

UHC considered our son's case to be mild; however, CT said my son

was high-end moderate. When I appealed our insurance, I included

CT's 'findings' and we won. We were going to band regardless of

insurance (although we obviously wanted insurance to pay). If you

can afford to pay for it, then I would do that then deal with the

insurance. If you can't and need insurance to pay first, I'm not

sure...maybe CT can work with you??? Good luck.

PS: I would go with what the specialists says in regards to

headshape NOT family and friends. Even though, some people could

see the plagio when I pointed it out (and one person asked me about

it...I didn't point it out) I was NOT happy with my son's head shape

and I didn't want to have issues later or regret my choice not to

band. I am SO glad we banded. My husband was even one of the

people that said our son's headshape was fine BUT he knew that I

disagreed and was very supportive with the whole process. Like

, my grandma still denies that our son had any flattening too

(even with the before and after headsicles to show).

> Hi. I am new to this group but already have learned so

much from

> reading all of your posts and the files. It has been very helpful.

I

> have a DD who just turned five months. She was referred to a PT for

> torticollis and positional plagiocephaly at 4 mo. We began PT and

> stretches at home right away for her torticollis and she is doing

very

> well with that. We went to Cranial Technologies to have her

evaluated

> for the DOC Band and they determined she was a moderate - high

rating

> of plagio and felt she would be a good candidate for the band. She

> also has some assymetry with her ears and eyes. We decided to go

> through with the band and started the approval process with our

> insurance co. only to be denied. We have Humana PPO and they denied

> it on the basis that they consider my daughters condition to be

very

> mild and the band to be unnecessary. I'm wondering how they can

have

> such different standards for need. We even had a letter of medical

> necessity sent to them from my pediatrician. I've been struggling

> with whether or not to band my daughter from the start because the

> friends and family that Ive confided in have told me that I'm being

> " nit-picky " and that she is fine. I've read all the info about what

> untreated plagio and tort can lead to and I don't want that to

happen.

> I guess I'm looking for some suggestions on what to do about the

> insurance and if they continue to deny our claim... do you still go

> ahead with treatment and figure out how to pay for it later??? Or

do

> you wonder why they consider it to be mild when CT says its on the

> high end of moderate??? I'm very confused and would appreciate any

> suggestions or input. Thanks!

>

> ---------------------------------

> Be a better pen pal. Text or chat with friends inside .

See how.

>

November 18, 2007

I did receive measurements for my daughter. They were as follows...

Cranial Vault Asymmetry: 13mm

Mid-Face Asymmetry: 2mm

Skull-base Asymmetry: 3mm

Cranial Tech said that they forwarded my daughters photo study, the

insurance measurement report and the clinical evaluation report. When

I was told that the insurance denied our claim I asked what the

insurance company standards were and was told that they don't use a

number system, they just have either mild or severe and my daughter

doesn't have a severe enough case even though they is the high end of

moderate according to CT.

As for going ahead with the band without the insurance and then

fighting later, I already know that my insurance would cover 90% if

approved... but if I go ahead with any services without their approval

and fight afterwards they will only cover 50%... that's a big difference.

>

> Did they give you a specific # of mm off?

> There are industry standards or guidelines - Molly knows alot about

that - and some ins. companies won't band under a certain #.

>

> I do know that some parents go ahead an band and then fight with the

ins later - because timing is of the essence.?

>

> Jen and Luli - 23 months

> Left tort - Right Plagio - Hanger Band Grad - CA

> http://www.babiesonline.com/babies/j/jens5th/

>

> In need of guidance...

>

> Hi. I am new to this group but already have learned so much from

> reading all of your posts and the files. It has been very helpful. I

> have a DD who just turned five months. She was referred to a PT for

> torticollis and positional plagiocephaly at 4 mo. We began PT and

> stretches at home right away for her torticollis and she is doing very

> well with that. We went to Cranial Technologies to have her evaluated

> for the DOC Band and they determined she was a moderate - high rating

> of plagio and felt she would be a good candidate for the band. She

> also has some assymetry with her ears and eyes. We decided to go

> through with the band and started the approval process with our

> insurance co. only to be denied. We have Humana PPO and they denied

> it on the basis that they consider my daughters condition to be very

> mild and the band to be unnecessary. I'm wondering how they can have

> such different standards for need. We even had a letter of medical

> necessity sent to them from my pediatrician. I've been struggling

> with whether or not to band my daughter from the start because the

> friends and family that Ive confided in have told me that I'm being

> " nit-picky " and that she is fine. I've read all the info about what

> untreated plagio and tort can lead to and I don't want that to happen.

> I guess I'm looking for some suggestions on what to do about the

> insurance and if they continue to deny our claim... do you still go

> ahead with treatment and figure out how to pay for it later??? Or do

> you wonder why they consider it to be mild when CT says its on the

> high end of moderate??? I'm very confused and would appreciate any

> suggestions or input. Thanks!

>

> ________________________________________________________________________

> Email and AIM finally together. You've gotta check out free AOL

Mail! - http://mail.aol.com

>

November 18, 2007

Who is your insurance provider? Perhpas some other members with the same

insurance might have some advice.

Molly