First fitting and adjustment
This is the Mess Maker at about 6 months old being casted for and then fitted for her DOC Band corrective orthotic helmet. We are hoping to be able to avoid this course of treatment for the Noise Maker, as it is very costly and time consuming, especially since the closest Cranial Technologies (maker of the DOC Band) to our home is about 3 1/2 hours away!
These helmets cost $3,000 and most insurance companies do not pay for them (or at least try not to), claiming they are "cosmetic" in nature. If left untreated, plagiocephaly has been noted to cause difficulties for the baby later in life and has been linked to visual, hearing and oral disturbances as well as developmental delays. Shortly after the Mess Maker's helmet casting, we received notification that the helmet would not be covered by United Healthcare.
Thus, my battle with the insurance company to gain reimbursement for the helmet began. United Healthcare gave us the "cosmetic" excuse for denial of coverage and said they would not be reimbursing us for even a portion of the cost. I sent what I call a "mild appeal" at that point, which was denied. So for the next six months, I researched and collected any and all information on the subject of torticollis and plagiocephaly. We sought medical opinions from many different specialties, including an orthotist, a pediatric plastic surgeon, two physical therapists, a nurse specializing in custom orthotics and of course the Mess Maker's pediatrician. Each of them submitted letters stating the medical necessity of the helmet and those letters along with my 10-page appeal and over 200 pages of research and information in support of my case was bound together and sent in as my second appeal to United Healthcare. Two months later, we had our reimbursement!
We are in the minority of those familes that receive reimbursement...so I shared, and continue to share, my appeal packet with any parent that requests it so they can hopefully get the reimbursement they so much deserve.
Click on title "The Mess Maker's DOC Band" above for information about plagiocephaly.
.jpg)
9 comments:
Hi. I ran across your blog when I was doing research for my daughter's plagiocephaly and our battle with UHC. We have just begun the battle with the insurance company and I would love to hear any advice you might have for getting reimbursed. Thanks.
Hi Maureen,
Thanks for contacting me! I would love to help in any way I can. I posted my appeal (minus the research articles) on the Plagiocephaly Yahoo Group...are you a member? If not, I would highly recommend it: http://health.groups.yahoo.com/group/Plagiocephaly/
I would be happy to send you a copy of the CD I have with the research articles I used to support my appeal...just send me your mailing address and I'll get one out to you. I've sent probably 25-30 of them to other people needing appeal help!!!
I would just make sure you make mention in your appeal that you know of other cases that UHC has approved (and there are!!!) and that you feel it's discrimination that they are not approving yours. You can even site others if you can find their names on the Yahoo group or elsewhere...
Hope this helps, and let me know if you have more questions... :)
THCEO
Hi, I also came across your blog while I was looking for information to support our claim to UH. He took out a loan to pay for our son's doc band. They will cover their in-network provider's helmet and treatment, but they are not a specialist in orthotic care with children. Did you run into this as well? Please mail me your cd with the supporting documents. I am now ready to begin the war, you gave me the inspiration. Now that I can be done, it's only a matter of getting it now!
Thank yo SO much!
Holli- NC
Hi Holli!
I don't know about your specific policy, but I know with ours that CT was considered "out of network" so they only paid 60% (once we finally got reimbursement!)...I know that if we had gone with a local Starband doc (not a helmet specialist, just an orthotist), they would have paid more. But I just felt more comfortable with CT (since our local orthotist didn't specialize) and if I had to do it all over again, I would do the same thing.
I'd love to help you...the articles would be expensive if you had to try and get them without being affiliated with a university!!! I had the luck of having a husband going to school at the time so I was able to obtain them for free. I've sent the CD out to a bunch of families needing help fighting their insurance companies and I am happy to share it with you...just email my your mailing address and I'll stick one in the mail!
TheHouseholdCEO@live.com :)
Above comment removed to protect comment author's personal information.
Holli, I'm putting the CD in the mail today!!! :)
Hello! I came across your blog and I have been looking for all the information I can on appealling an insurance decision. I have gone to Hanger, Cranial Tech and to the Star band and everyone said it won't be covered. I have done tons of research but nothing seems to be very compelling except the South Carolina suit regarding the band. I have had a very long talk with my insurance copy who says that they are overed under measurement circumstances but are case by case. Any help is appreciated.
Hello! I came across your blog and too am in the process of appealing my insurance company. My 9 1/2 month old daughter has brachycephaly with plagiocephaly and requires 2 DOC Bands. UHC denied any coverage, so we have spent over $7,000. We were denied after the 1st level appeal and are working on gathering information for the 2nd level appeal. Would you be willing to send me the resources you used? Getting the insurance company to reimburse part of the cost is better than nothing. Thanks!
Hi Holli Please send me the CD i would love to have some assistance in this case we are dealing with the same thing w my son
Post a Comment