Plagiocephaly, Cranial Bands and Insurance

Maverick developed a condition in utero called Torticollis. Because of this, he then developed Plagiocephaly that got worse after he was born from his neck always being turned to one side. When he was 4 months old, we were told he needed to wear a "helmet", or technically, a cranial band, to help improve the assymetry of his head. We were sent to Cranial Technologies to get a Doc Band. These people have been awesome and we're so grateful for them!




Last thursday Mav got his Doc Band off after wearing it for 3 1/2 months. He had significant improvements and we were told he went from having a severe plus plus head shape to a moderate/severe headshape. It was also recommended that he get a 2nd Doc Band. We of course want the very best outcome for our little man, but here's the kicker. We were told when we got his first band that almost in every case, insurance, no matter what insurance you have, will not cover it. We were so fortunate, or so we thought, that Tricare agreed to pay for the whole band!! It wasn't until a couple weeks ago I got a call from our insurance coordinator at Cranial Technologies telling me that Tricare still has not payed them and that she found out that it was the WRONG Tricare (West instead of South) that had agreed to paying for it. We will not know for another couple of weeks if South agrees to pay for it, but most likely they will not and then we will have to work on our appeal since it wasn't our fault that we didn't know it was the wrong insurance who had agreed to pay for it in the first place! Meanwhile, I found out yesterday that Tricare South denied our request to pay for his 2nd band. Unfortunatly, that means paying $2500 out of pocket, and if they don't agree to pay for the first one, that will be $5000. Although I am so glad they have covered what they have for all of Maverick's other healthcare costs, I find it unacceptable that insurances typically refuse to cover these bands unless it's post-surgical. And even though $2500 is a lot, that is with a military discount. The regular amount for civilians is around $3800. There are many many twins out there who require these bands due to conditions that happened while in utero (just like Mav) so those poor families are left with over $7000 worth of bills just for the first bands and over $15,000 if they need 2nd bands. This is completely rediculous and unacceptable in my humble opinion. I think insurance companies need to be a little more educated on this subject! We're not wanting our kids to wear these "helmets" so they look cool and we get tons of stares from people wondering what's wrong with them! John and I were told by the neurosurgeon that prescribed Mav's first band that if he did not have this, he could and would probably end up having a life-threatening surgery later in life that Tricare would have to pay for. So...does this even make sense to not pay for it NOW?? No it does not! Anyway, just thought I would do my part in Plagiocephaly awareness and in the mean time I will pray that one day the insurance big wigs will educate themselves and be on board with this. Thank you Dr. Klugh and thank you Cranial Technologies for caring about Mav and helping him have the best outcome possible!

(I wish I could figure out how to upload his before and after pics but I can't at this time)