Did you have to pay for your helmet?

[kayzie]

Did you have to pay for your helmet? If so can I ask how much it was?

[kayzie]

Anyone?

[amizzle]

We paid for our first one $1500! Luckily by some miracle insurance reimbursed us all by $300 dollars, and we have only paid $300 on the following helmets. How much are they telling you yours would be?

[kayzie]

We paid for our first one $1500! Luckily by some miracle insurance reimbursed us all by $300 dollars, and we have only paid $300 on the following helmets. How much are they telling you yours would be?

They charge insurance 1800 and we have to pay 20% which is 360. If Ins wont pay we have to pay 1440. I just wondered what it should cost. Not like we have a lot of options, only one center in our state does this.

[Holly]

I beleive both my boys helmets were around $2000. We didn't have to pay because at that time they had medicaid. They scanned their heads and shipped the helmets to I beleive flordia to be made.

[Jenny]

We didn't have to pay either, because she had medicaid, but I beleive it was somewhere around $1600 each and that was 5 years ago.

[Seagrape]

Leah just got scanned for her helmet May 6th. Ours should be covered completely by ins. because it was related to surgery. We have BCBSofFL. We were told our "therapist" is out of network so we may end up paying a portion...not sure yet. But they said we have to pay upfront and they have a packet put together for us to submit to get reimbursed.

They fee we were charged was $2650 total for one helmet, scanning, the therapist who checks it and makes adjustments every 2 wks, all adjustments etc. We had to pay 1/2 upfront and the other 1/2 when we get the helmet. Then they said she will probably need at least one more helmet. She has to wear 3-6 months total.

[AuburnLocks]

Patrick's helmet was not post surgical (he has plagio). Our insurance paid since we met their criteria --greater than 6mm of asymmetry (he had 12mm), older than 4 months, and attempted repositioning for more than 2 months (even though, with his type of plagio repositioning really wouldn't have made any difference anyway. But we did it just to say we tried.)

Ours was around $3000, we paid $200.

[kayzie]

Ours isnt surgery related either, he has plagio. We have not met the two months yet though, not on paper anyway, so I guess I shoudl wait another month? He has a large lump at the top of his head where his bones are overlapping now. Im worried they COULD fuse. Im not sure how urgent this is at this point.

[AuburnLocks]

No one really knows what causes the bones to fuse, there are lots of theories, but I do know that you can not cause it or prevent it. Not doing helmet therapy is not going to harm your son so you can definitely stop worrying about that one at least.

He's six months right? In that case you do have some time. It is most effective in the first year so you don't want to wait too long but I don't think the situation is urgent either.

Each insurance company has different rules. Ours (Aetna PPO) spelled out very specifically what they would and would not cover. They required that he be over 4 months, that the letter of medical necessity from our doctor had to say we had tried repositioning for 2+ months (even though, like I said, for his type of plagio which was caused by in-utero molding, not a classic "flat spot" it really wasn't going to make any difference) and we had to show through measurements taken by the orthodist that he had more than 6mm of asymmetry.

The insurance specialist at Cranial Technologies (the company we used, their device is called the DOC Band) actually handled all of the pre-approvals and even told our doctor exactly how to word the letter of medical necessity to make sure it got covered.

Do you have a prescription already? Can the helmet company help you with the insurance stuff?

Also, if you haven't already, check out the info at CAPPS kids and the Yahoo plagiocephaly group. both have loads of info on insurance.

[kayzie]

No one really knows what causes the bones to fuse, there are lots of theories, but I do know that you can not cause it or prevent it. Not doing helmet therapy is not going to harm your son so you can definitely stop worrying about that one at least.

He's six months right? In that case you do have some time. It is most effective in the first year so you don't want to wait too long but I don't think the situation is urgent either.

Each insurance company has different rules. Ours (Aetna PPO) spelled out very specifically what they would and would not cover. They required that he be over 4 months, that the letter of medical necessity from our doctor had to say we had tried repositioning for 2+ months (even though, like I said, for his type of plagio which was caused by in-utero molding, not a classic "flat spot" it really wasn't going to make any difference) and we had to show through measurements taken by the orthodist that he had more than 6mm of asymmetry.

The insurance specialist at Cranial Technologies (the company we used, their device is called the DOC Band) actually handled all of the pre-approvals and even told our doctor exactly how to word the letter of medical necessity to make sure it got covered.

Do you have a prescription already? Can the helmet company help you with the insurance stuff?

Also, if you haven't already, check out the info at CAPPS kids and the Yahoo plagiocephaly group. both have loads of info on insurance.

I just moved our orthotics appt out farther so that the insurance co will know we tried positioning long enough. I dont want to drive back and forth to this center for no reason, so Im going to make sure Ive met their requirements.

[CourtneysMom]

Did you have to pay for your helmet? If so can I ask how much it was?

We were very lucky in that our policy with UHC covered it. If we had to pay out of pocket it would have 3800.00 for the helmet and the weekly, biweekly fittings. That's in addition to the StarScans (which insurance did not cover)

[spoongirl10]

My insurance luckily payed for our helmet. I believe it was $3400. The craniel center got them to pay for in network benefits.

[JHILL9]

We have fought the insurance company every step of the way. We have appealed 3 times and are now sending one to the state board. Each one needed a helmet and they were 3700 each and the post surgical helmet is covered.

[spoongirl10]

Mine denied it a few times. I have bluechoice. They just now paid for it and he's had it 2 months. They needed proof that it was surgically necessary. I'm thinking you idiots are A** backwards. You paid for his surgery and now you want proof that this is necessary. Would they rather pay for the helmet or pay for another surgery because the kids didn't get the proper treatment?? They would rather pay for a $20,000 surgery than a $3400 helmet!!! Don't even get me started on these stupid insurance companies

[kayzie]

Mine denied it a few times. I have bluechoice. They just now paid for it and he's had it 2 months. They needed proof that it was surgically necessary. I'm thinking you idiots are A** backwards. You paid for his surgery and now you want proof that this is necessary. Would they rather pay for the helmet or pay for another surgery because the kids didn't get the proper treatment?? They would rather pay for a $20,000 surgery than a $3400 helmet!!! Don't even get me started on these stupid insurance companies


oh boy...we have blue choice too:no

[spoongirl10]

Well i luckily didn't have to appeal it myself. The cranial center took care of it for me. They denied the whole thing, then paid 60% of the helmet, took that back and then I rec'd two checks in the mail. One for 1500 and one for 1900. So i didn't bother asking any questions. But these insurance companies really do kill me with the way they work.