View Full Version : Insurance not covering helmet
08-24-2008, 09:17 AM
Hi there! Well, lucky us, insurance has decided not to cover the helmet (not that we weren't prepared for the possibility but still). It blows my mind that insurance covered the stripectomy operation but refuses to cover the helmet therapy that typically follows up this type of operation. *sheesh*
Anyways, we were given procedure code "S1040" as being denied. Just wondering if those of you who had the helmet covered by insurance submitted a different one for review. Just looking for different angles to try and get this covered - any information is greatly appreciated!
08-24-2008, 09:21 AM
Sorry I can't really help as the whole insurance thing just blows my mind (I'm originally from UK!). Anyway I just wanted to say that I hope you can appeal and they do finally cover it. It's not as if it's being done by choice! Best of luck.
08-24-2008, 12:47 PM
They told us NO WAY our insurance would cover the helmets (we have United Health Care). Surprisingly they covered all but 300 dollars of each one. It really was a miracle. Sorry you are having a hard time.
I am pretty sure we had the same helmet code. Who do you get your helmets through?
We were prepared to fight (to the death :)) to get our helmets covered when we thought they wouldn't be. We heard our insurance thinks of helmets like a retainer. seriously???? Well our surgeon said he would write a letter to the insurance company and the helmet people said they would too stating how the helmet is a NECESSITY after a strip craniectomy. Maybe you can try that for starters.
Best of luck!
08-24-2008, 01:08 PM
Grrrr... I don't get it, it's 2008, there are so many new treatments for cranio that these insurance companies don't know about. It's mad!!
I agree with Amy, get the Dr. and the helmet place to write a letter to the insurance company. You have to educate them because the know so little about cranio. Be that squeaky wheel!!!!
Keep us posted and GOOD LUCK!!!!
08-24-2008, 01:13 PM
Thanks for the advice! We have an appointment with the helmet place (Hanger) tomorrow so I figured I'd start with them. I'll ask the neuro to write a letter too. It really is amazing. I found information stating there are 2 types of S1040 - one for plagio which is considered cosmetic (!!!) and the otheris postsurgical therapy (*DUH*) so I'm not sure why my insurance company (Blue Cross) is giving us such a hard time. Guess I'll have to win the lottery next week if nothing works out. ;-) Stay tuned!
08-25-2008, 12:02 AM
my husband and I just had a little bit of a fight on our hands with our insurance and Jack's helmet...
We were originally given an "old" code and they told us that we needed to have very clear descriptions of what the helmet was for with every person we talked to and with all the info that was sent in by the helmet people...
My dh dealt more with this than I did really, so I'll ask him tomorrow and let you know any more details...
Don't give up is my biggest advice though... My Dh spent a lot of phone time with ins. -- He found one person that gave us an affirmative and got that persons extension and would only deal with her...
We were also told that our ins. would cover the helmet for "post op" as long as Jack was between "4 mo-12 mo"
09-03-2008, 09:18 AM
Have your Dr.s write a letter about why it is medically necessary for his development. You can go a step further and have them say for his "neurological" development. You have to keep up the calls. I am sorry you are going through this. I know it is a pain.
09-03-2008, 01:33 PM
fight, fight and then fight some more. These insurance companies count on people giving up easily. There is some good information on appealing insurance on the cappskids sight. Most of it is in regards to Plagio, but the format of the letters etc. still probably applies.
03-28-2012, 03:13 PM
Did you ever get the insurance to cover your helmet? And, what did you do? I can't beleieve that 4 years later nothings changed. We have United and we're fighting them to cover this. Grrrr
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