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12.01.2010

Looking For Help With A "Helmet Therapy" Insurance Appeal?

The Mess Maker and the Noise Maker were both born with Torticollis, a tightening in the neck muscles on one side, which made it difficult for them to fully rotate their heads.  Both went through rounds of Physical Therapy to treat the disorder, but the Mess Maker (above) ended up having to wear a special helmet for several months to correct the abnormal head shape that resulted from sleeping mainly on one spot of her head (see below).
This process was ubelievably difficult, stressful, time-consuming and heart-breaking...especially the casting part of the experience (which probably upset me more than her!):

And the worst part of the whole ordeal was fighting with our insurance company.  They wouldn't cover the costs of Helmet Therapy, claiming it was only "cosmetic" in nature.  We were out $3,000 for this much needed device.

I spent months researching and gathering information for an appeal.  A lot of people I came in contact with in similar situations had been denied coverage by their insurance companies as well.  I was determined to get coverage, and was able to compile an unbelievable amount of resources supporting the medical necessity of Helmet Therapy, which I turned into a 250-page successful appeal packet.  I would be happy to share this information with anyone interested.

1.  My 10-page appeal letter (entire document can be found HERE).



2.  If you would like a copy of my appeal resources and information, please email me your mailing address and I'll mail you a CD with all of the information I used.

TheHouseholdCEO(at)live(dot)com

If you have been denied coverage for a Star Band, DOC Band, Hanger Band or any other type of Helmet Therapy by your insurance company, don't give up!

9 comments:

Anonymous said...

Hi,

I've been following your blog for a few months. Love your creativity. I don't need the appeal for Helmet Therapy but I just had to comment to say how nice and free-hearted you are for sharing your experiences and your appeal. You are such an inspiration and example to what humanity really is. God Bless you for this.

Shica

Lori (THCEO) said...

Wow, thank you so much for that...you just made my day! My hope is that if I can spare just one person from going through what we went through, then I've made someone's life just a little easier... Love payin' it forward! :)

-Lori

It's Jenn! said...

How absolutely sweet of you to take the time out of your day to share your hard work like this. A friend of mine's son has torticollis and while he didn't end up needing the helmet, it made me think of him. You are such a wonderful person for sharing this with people who may need it. Thank you =)

teachdanz said...

My youngest daughter went through pt and a helmet too!! And we paid it all but thankfully I was able to do it locally so it was only a couple of grand out of pocket. I had a coworker who had to fly to her son's doctor cuz it was such a new issue at the time. I will keep your info on hand to help others. Thank you!!!
btw I am so glad I chose to fix it!! she was considered moderate facial deformity and now she is such a beauty!!

Jamie said...

awww how awful! Im glad you were able to get it figured out though. Not enough that you had all of the emotional and physical problems going on but they had to add the money issue too. As far as Im conserned a child's health/safety should never be a money issue.. there are so many people who don't have the options to do what is best for their kids.. insurance companies really don't care and its sad. And even more sad than that is your pictures :( poor baby girl Im glad shes better now though. It is so nice of you to share this resource with others so that they may not have to deal with such things. :)

4kids4 said...

I agree with Shica...this is soooo kind and generous of you!

The Mommy said...

Lori, I had no idea! What an amazing gift you are giving to someone in similar shoes. Thank you for sharing this information! I want to pass on your post if that's ok.

Tricia said...

Wow it is amazing and a great idea to share your information with others that may struggle with the same issues. My son who is now 14 months old just recently got out of his helmet. I had the same problem with the insurance denying coverage due to being "cosmetic" however after fighting and talking to MANY nurses, doctors and reps at the insurance company they finally did cover since my son was born one month premature, had torticollis, spent week in ICU on flat side of his head in the incubator and then also had respiratory distress syndrome. It was strange the things they needed to know that actually qualified him. It is so sad the issues everyone has nowadays getting coverage under insurance plans that we pay for to help us get the medical needs for ourselves and our children.

Nancy S said...

Wow. Reading your dilema and then reading what others have to say and have gone through only makes me more thankful to be Canadian and have these expenses covered for us by our Health Care System. I'm sure if it was one of the Insurance Companies children with this problem they would not think twice about allowing the claim. I'm sure your child will thank you as she becomes older and more beautiful each and every day. TFS you story.