Anyone Else Have a Kid Needing Doc-band Treatment?

C.,

I had a similiar situation. My son's pediatrician recommended a Doc Band when he was about 6 months old. We have United Healthcare as well and were denied coverage. Since my son's case was pretty mild, we went to physical therapy for a few sessions and did the whole re-positioning throughout the night and at naps - as well as just making everything interesting on his unflattened side - it helped a lot and made the Band unecessary. I also did the whole appeal process - which consisted of three appeal letters and three rejections. If we had done the Band, it would have been completely out of pocket. I have heard from some other people with United Healthcare that had the same experience with the Band being denied. There are a few good websites that have sample appeal letters and lots of other information. If you are going to appeal, I highly recommend researching on the web, you'll get a lot of information and won't feel so alone in the process. It is a stressful time and any support helps - let me know if you would like more info on the sites/appeal letters.

Good luck! C.

C.,

Hi, my son (1-year old) just got off the band last month. He wore it for 4 months. Did you have your pediatrician write a letter of medical necessity for your son's band along with prescription? I turned in a letter of medical necessity when I filed the claim. DOC should offer you 10% discount, if you pay all the treatment up-front, so you really have to pay only $2,700.00. I know that it is still a lot of money, but you still can save some money. When you do receive the discount, you have to file the claim to your insurnace company my yourself, but the ladies in DOC will help you for all paper work. My insurance company agreed to pay $1,800.00, because I turned in letter of medical necessity to them. I remembered that all processes were so long - both insurance reimbursement and treatment, but I think it was worth all effort. My son's H. shaped really bad, and I started seeing great improvment in a month or so. Now, he had a small area that is still a little flat, but I am happy how it turned out. DOC recommended to do 2nd band, but we did not do that, because our insurance did not pay for the 2nd one, and my pedi did not think that it was necessary. I guess that one thing I did not like was that he sweated so much inside the band, and felt really sorry for him. He got rash on his H. and face, because he had to wear it for 23 hour/day. Good luck to you and your baby, and let me know if you have any questions.

T.

My son got a DOC band right around the same time (2 years ago). We had a really hard time with scheduling, insurance etc. The technician at the clinic (which was in California) was not very helpful or forthcoming.

However, I did a lot of research and found that their technology is the industry standard and would be the best bet for my child getting his H. corrected. He wore the band a bit longer than the standard therapy, and it worked wonders. His H. looks great and I am thrilled that I went through the process. We also had an issue with torticollis and we had to do stretching exercises with his, and those were imperative to the success.

I also had United Healthcare (again, California's version) and they initially declined to pay. I wrote numerous letters and called countless times to try and get them to pay. I was eventually successful, and had they paid based on the fac that I pointed out inconsistencies in their plan that just were not logical. It was a huge undertaking, but our band cost more like $4000 and I didn't want to have to pay for it just on principle.

Sorry for the rambling, I am not sure if this is making any sense. I guess my point is that the band was great and it corrected my kids H. beautifully and I was able to get it covered 100%. I would be happy to discuss with you if you are interested in how I convinced them to pay.

____@____.com or ____@____.com

I just was wondering,did the peditrican refer you to have this treatment done? Or did you go to a specialist first, that told you you needed the doc-band? The reason is because my son had the same problem with his H. being flat and my peditrican told me I had to get a helmet or a band to help get his H. back to normal. I went to the specialist at 9 monthes and he said my sons H. would eventually correct itself as he grows, and I did not have to spend thousands of dollars on these treatments for bands or helmets. He is now 2 1/2 and his H. is completley fine. If I would of listened to my peditrican I would of wasted alot of time and money. But I don't know how severe your son's H. is. My advice is just be sure he really needs this before spending the money or wasting any more time on this. Hopfully you have already seen a specialist. I also had to go back to the specialst a 2nd time because my peditrican did not agree with him. The speicalst also said that many times the peditricans do not know alot about this subject since it is becomming more common now and used to not be because of the SIDs subject of babies having to lay on their backs. Therefore they will refer them to places like your going,and these places will tell you you need to have these treatments when many times the babies heads, if not too severe can be corrected on their own. Hopes this advice helps!

A friend of mine (her son) had this same treatment. Her insurance didn't cover it, and she had to pay for it out of pocket. She was never reimbursed. She just paid for it herself.

C.,

My daughter had a DOC band when she was 4 months old....she now is three. We had a great experience with Cranial Technologies. It did take a long time to get everything in order as far as insurance goes, but I never had trouble checking on the status of things at their office. They were always very helpful. You might want to stop by in person to do a status report. I would really keep hounding your insurance company to pay...mine did but it was questionable at the start. Cranial Tech. is the best place to go and you will love the results! You will also be amazed at how fast you start to see them (results.) Hang in there, a few weeks will not make a huge difference for your son....once it gets going he will be on his way to a beautifully shaped H.!
If you have other questions....my email is ____@____.com

Good luck!

Hi C. my son wore the doc he is now five and has a beautiful H.. If you would like to call me to discuss it I can be reached at ###-###-#### we used cranial technologies and loved it. I am disappointed with your experience with them and would love to pass your information on to the H. quarters of cranial tech if you would allow me to. I used to moderate an online support group for the condition that requires doc banding. It is called plagiocephaly.org and the groups is a yahoo group. Join it asap if you can you will get plenty of guidance there. I have been away from the board for gosh 3 years now but if you archive you can find me - bbbhand was my screen name. I would love to chat with you and welcome a call or personal email to ____@____.com if you would like. the best advice about insurance is appeal appeal and appeal again you can often get the decision overturned with the right diagnosis code or documentation i can try to guide you with it as well but on the plagio site there are appeal letters and united health care specific forms you can use. I can try and help you with this as much as possible since I am a health care social worker but have been away from that for 5 years as well. we had uhc with my sons treatment and got coverage. I would need to know what your durable medical equipment rider says on your policy and who supports your ins. self insured through a work group etc. This is a very scary time I was so frightened during this process but in the end it was worth all of the tears - really. but your window of opportunity is narrowing- although you can band after 12 months the prime growth time is right now and you will see the most correction the quickest the earlier you have them banded. I could go on and on really about all of this. I am sure you have gotten some great responses but if you need more or if I can answer any questions please feel free to call me. B.

My son had to have a Doc band and we also went through Cranial Technologies. We weren't sure if we would have to pay for all or part of the cost and it did take a while (like a few months) but our insurance finally paid. They paid out of network and we ended up paying around $800 but he needed it really bad. We have AETNA by the way. My understanding was that sometimes it depends on the severity of the plagiocephaly which is what determines if they will cover the cost. I hope this helps.