them doc band

i ahve a set of twin boys now 6mth old(adjusted 4 mths) recently me and theire dad were told that caden would need to wear a doc band. the problem is that my insurance will not cover the band. does anyone have any suggestions about how i can get around this problem with my insurance company?also he is only 11cm off is it a serious problem if we cannot get the band for him? pease if anyone has any advice i would love to hear it.

 

i ahve a set of twin boys now 6mth old(adjusted 4 mths) recently me and theire dad were told that caden would need to wear a doc band. the problem is that my insurance will not cover the band. does anyone have any suggestions about how i can get around this problem with my insurance company?also he is only 11cm off is it a serious problem if we cannot get the band for him? pease if anyone has any advice i would love to hear it.

 

I don't have any personal experience with doc bands, but I will link this to First Year Forum were maybe someone there has.

 

Hi!

Are you saying the measurement difference between the flat spot and roundest spot is 11cm? My son wore a helmet and the difference was measured in mm not cm. Kyle was 17mm and his condition was considered severe. If your son is measuring 11cm then that means 110mm which would be extremely serious! Our insurance covered anything 11mm or greater.

I would suggest an appeal to your insurance company, you can find sample letters here and here.

I would like to know more about your situation because the 11cm really has me stumped.

 

Hello,
I don’t know anything about the band or what condition it’s for, I’m sorry.

My son has scoliosis and needs treatments not covered by our insurance so we signed up for calif. Children’s services and now they pay for any scoliosis related surgeries and treatments, while we still need our insurance for other health stuff.

If an appeal to the insurance company does not work, try asking your doctor or look in the phone book to see what local or government health agencies you can apply for.
Best wishes

 

wow omg i did put cm om i met to say mm. i am so sorry lol. yea if it
was cm i think it would be pretty severe. o sorry its called lac of sleep. i have the twins and a 3 yr old and work full time so i dont get much lol. thanks for the site imma try an appeal letter hopefully that will work. wha if not? do u know the outcomes besides the shape of the head? any medical cond that u know of? i feel so bad that i cant seem to get it for him. it has been strerssing me out trying to figure out what to do.


thank you

 

I also have been considering the bands for both of my twin boys. However, my pediatrician feels that they are not necessary. She even called a colleague of hers who is a pediatric neurosurgeon and he said, quote, "I hate, hate, hate, the band companies because all they do is prey on the emotions of worried parents." He said that in 99.9% of cases (baring any other medical condition) the heads will round out on their own once the babies are sitting up, crawling, etc. My insurance won't cover them either and at $3000 each it seems outrageous.

Just another opinion. I'm still not sure what we're going to do but it seems that all the advice from medical people is to wait.

 

Here is the major thing in my opinion. If the condition was caused because of position then generally speaking it can be corrected by position. If the condition was caused inutero, meaning the head never formed correctly in the first place then treatment is more generally needed. When he was born was his head round? For my son the condition was inutero, he was head down my entire pregnancy with the weight of his sister on top.

Some other major factors to look at the facial features. If you look straight down on his head and draw a straight line, does it connect both of his ears? If you hold him up to a mirror are his eyes level, how about his mouth? Again, generally speaking cases where there is just flattening in the back position alone can work. Cases where the facial features are misaligned generally require treatment.

I did not pay one penny for the helmet my son wore, it was not a DOC nor a STAR it was just a molding helmet, kind of like a cast for his head like if someone broke their arm or leg. I don't think anyone would say the cast companies are just out to make money so I don't quite understand why someone would say that about the helmets but to each their own I guess.

So, the two biggest things that would decide for me if treatment was needed is 1) how the condition came about and 2) if there is anything else besides just the head flattening.

I wrote about our experience from start to finish here. I hope you find it helpful.

 

thank you so much for helping. yes when he was born his head was round it has just been recently that it has started to get like this. it is due to a tight muscle in his neck is what i was told. he been going to phys. theropy for his neck and they say he has improved so much but his head has not shaped out. i dont know how to word it his head is not really flat at 1 part it is more side ways if that makes any sense to you.his face is a little off aligment but no very bad. people can tell though b/c i have got rude comments like"why is your babies head croked?"i have accually had people make fun of him not knowing i was around. thats part of my big concern as he gets older if it doesnt shape kids are mean now a days and i dont want him to have to go threw that. my insurance will not cover and im debating wether or he really needs it.

 

I am a peds PT and I do not necessarily agree with the arguement that it is not needed if it did not occur in utero. Since the start of the "back to sleep" campaign to encourage sleeping on the back for prevention of SIDS there has been a huge increase in in the cases of positional plagiocephaly (flattening of the head on one side) and torticollis(tight neck ms on the opposite side of the flat spot). In most cases, once the parent is educated on alternate positioning and tummy time, the head shape improves dramatically when it is caught early. The problem comes when the head gets so flat that the baby also develops significant torticollis because the flat spot is so prominant and the baby cannot turn their head over the flat spot to look to the opposite side. When there are significant medical concerns due to torticollis and assymetry of facial feature (which can cause misalignment of the jaw and effect chewing), often a DOC band is the only solution. I know that medicaid and most insurances are not paying for helmets when they consider it cosmetic, but if he is going to PT and has torticollis that is not getting better, you may be able to have the pedi or a craniofacial plastic surgeon write a letter of medical necessity to appeal the insurance denial.

 

I agree with the pp, and Dianne is totally right, you need to take te time to write to your insurance and appeal to have them cover the helmet (band). If he is going to PT and has torticollis, that should give you sufficient evidence to appeal their decision esp. if you get the pedi plastic surgeon to weigh in on the subject. Good luck. Keep us posted

 

quote:
I am a peds PT and I do not necessarily agree with the arguement that it is not needed if it did not occur in utero.
I don't think anyone said that. What I said was in general terms, there are obviously exceptions to all generalizations. What I was doing was trying to give her some information to work with to decide if persuing appeals and treatment was the right or wrong decision for her and her son. I gave quite a few things to look at, think about and how the condition came about is definitely something that should be added into the equation in my opinion.

The problem is those of us who have used helmets to treat our children often have to walk on egg shells when responding to posts such as these because if we say oh yes get a helmet then we are told we are dumb because the helmet industry is just out there to make a buck from us (which I did not pay one penny out of my pocket for) while on the flip side if we say no don't get a helmet then a few years down the road when the children's eyes, nose, mouth, ears are misaligned parents will wonder why, KWIM? Kind of like some doctors get the reputation of telling every parent they need a helmet no matter what, the same happens for parents of children who have been treated. I am trying hard to break that stereotype because I know not every child needs treatment and I like to explain why, which I hope I did above.

I have a 'friend' whose son developed a very flat head post birth and now at 6 years old people will look at him a little oddly and some will even ask what happened to him. This same 'friend' did not talk to me the entire time Kyle was doing the helmet treatment. Not sure if she was just upset because she didn't make the same decision I did, who knows but her son's condition definitely started by positioning after birth and I sincerely believe if she had persued the helmet treatment she would have gotten some great results. For this reason alone I would never say "treatment is not needed if it did not occur in utero". I think we need to remember that this is a forum for twins/parents of twins where many cases of head shape issues are indeed caused by position inutero, lack of space can be a huge issue.

 

Dianne, I was not trying to start an arguement and I am fully aware that this can be common with twins carried close to term due to lack of space. I just wanted to give out additional information because it is something I see everyday and because I have had several parents with the same issues regarding insurance and the cost of the helmet. I just wanted to make a point that positional plagiocephaly that occurs after the baby is born is much more common today and often does require treatment with a DOC band if it is not caught early. I would hate for someone to read this post and think that because it happened after their child was born that they failed if they were unable to fix it by positioning alone. Most doctors I work with will send a baby to PT and reassess the need for a DOC band only after positioning did not work. Sometimes, depending on how bad it is and how old the baby is, the head shape improves but not enough. It has become a real problem to the point that 1/2 of my schedule is filled with babies who have torticollis and plagiocephaly. With regard to insurance payment, the majority don't care if the shape changed in utero or after..it is cosmetic to them unless there is a medical need due to torticollis or facial misalignment. Even then it is a battle.
I agree, like everything, the primary goal of the companies that produce products like the DOC band is to make money. That being said, not EVERY single baby who has a DOC band absolutely needs it, but it does have it's place.

 

No argument here. quote:
I would hate for someone to read this post and think that because it happened after their child was born that they failed if they were unable to fix it by positioning alone.
I would too, thank goodness noone said that.

 

so now he was at the pedi about a week ago and the pedi is saying he doesny need the doc band nor a reg helment that its not that bad and hes too old. but the cranial dr sayd different. we really dnt know what too do. for those of u that used the helment did it dramt improve? for those that didnt use did the head reshape itself???he neck is fine now he can move to both sides with no problem so i guess im at a loss on who too trust.

 

I personally would lean towards the opinion of the specialist. Peds are wonderful but there are specialists and second opinions for a reason.

Kyle wore a helmet to treat his plagio. His condition improved from an initial measurement of 17mm to a measurement of 5mm in a few short months. I believe there has been additional improvement since then but we haven't needed any measurements since we were declared helmet free 4 1/2 years ago.

I do think you should make a decision and stick with it fairly soon since now a month and a half have passed since your initial post.

 

i would also lean towards the specialist. I say this only because my sisters ped missed that her son needed one (the ped also missed his torticollis). After going to a specialist and getting measurments, he received a helmet and it worked wonders.

 

my ped basically told me that the band companies are cash cows. what parent wouldn't feel guited into a band. i took both of my twins also but we decided against it.

 

quote:
my ped basically told me that the band companies are cash cows.
I did not pay a penny out of pocket for my son's successful treatment. If the band company we used is a cash cow then honestly it did not effect me. The only thing that effected me was the improvement I saw in my son's condition in a very short period of time with not even a single copay.

 

one more thing...i dont beleive they just want your money. The reason i say this is because there are actual measurments that you can see for yourself.

I took my son to get measured a few weeks ago and he scored mild to moderate and the spec. said right now he does not need one. He also told me he NEEDS to get out of sleeping in his carseat (which we did because of reflux and most recently because they simply got so used to it). They are now sleeping in their crib and luckily my son has made progress. However, he was never severe to begin with.