Insurance denied our claim for the helmet! :( — The Bump
Atlanta Babies

Insurance denied our claim for the helmet! :(

I'm on hold with the Dr. office to find out what to do now, but the letter states two reasons for denial:

No diagnosis of plagiocephaly and they require 2 months of physical therapy before covering it.

I feel like there is nothing we can do now. I'm going to try though. The Nuerosurgeon said they always say it is medically necessary. I have seen improvement, but her head is still lopsided. I just don't want to risk it being obvious later. She doesn't have much hair now, so it is hard to gauge how much that will help. She is only on her back or putting pressure on her head when she sleeps (usually on tummy though), in her carseat in the car or when I change her or feed her.

If money wasn't an issue at all, I would totally just pay for it and do it, but my job is unstable and we don't have much extra money anyway.

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Re: Insurance denied our claim for the helmet! :(

  • How much is the helmet?

    Can you play their game and wait the 2 mos physical therapy?

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  • Well, technically, nothing is wrong with her or there wasn't a cause for the flatness diagnosed so she doesn't need physical therapy. Plus, she is already doing this late in the game at 9.5 months b/c the drs dragged their feet in referring me to the orthotics place.
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  • It costs $3200 which isn't a ton I guess, but with a shaky job and when things are tight already. It's a hard decision for us.
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  • Insurance Companies Suck!  I hope you are able to figure this out... maybe your Dr has an extra trick up his sleeve to convince them???






  • That really sucks! I hate insurance companies and dealing with them especially.  I'm sorry they denied your claim and hope you and the dr. can figure something out.
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  • awww I am SO sorry you are dealing with this. I just had a screaming match with the insurance company regarding my zofran so I can totaly understand. I hope things work out quickly.
  • Ugh!  Insurance companies really suck.  I hope your doctor is able to make the insurance company understand why the helmet is necessary now and cover the charges.

    My insurance company tried to deny the claim for my CT scan last week, saying it was uncessary.  Hello?  I need surgery and the CT scan reveals where the issue is.  So stupid!

  • imageauburnbride2be:
    It costs $3200 which isn't a ton I guess, but with a shaky job and when things are tight already. It's a hard decision for us.

    That is a lot of money.  Try to go the phys therapy route if you can.  Demand a diagnosis, too, while you are at it.   

  • I would definitely try to get the diagnosis from the dr as well as try to get physical therapy going. Seriously, insurance companies are so incompassionate and just money hungry! I've been arguing with them all week long regarding my short term kicking in and they're just ridiculous.

    I'll keep you guys in my thoughts and prayers. (hugs)

    Derek 6.30.09 & Parker 4.1.11
  • Well, the problem is there isn't a diagnosis. I think with the Back To Sleep campaign for SIDS, a lot more kids develop flat spots. This paired with our lifestyles of being on the go, keeping our kids in their infant carrier carseats, and maybe just an inclination to one side has increased this in recent years. It could have even developed in utero, but we will never know. I regret that I didn't push for more repositioning help. I did the obvious things, but mayeb I could have done more. I regret that we aren't at 6 months old now figuring this all out. It just didn't seem severe and I honestly thought it would work itself out.
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  • I am sorry! Insurance companies SUCK!  I hope your dr can help you work things out and get the helmet w/o the massive expense.
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  • Appeal it.  Start playing their game.  Many times insurance companies will deny pricey claims.  Keep at them.  Demand help from the doctors, since they were the ones that prescribed one for her.  In the end, I think  you'll see that the squeaky wheel gets the oil.

    There's a reason why insurance companies make a ton of money.  They are stingy and will try to deny anything they deem "optional".

  • kepkep member
    That stinks! I hope they change their minds. Stay on them!
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  • Please don't give up! Please keep on them.  I fought for Nkosi asthma treatments to be insured as they kept dening him saying it is a pre-exsisting condition.  Hell ya he was born with it mutha...anyway.  I am, getting angry. Insurance companies in the US suck. I never had to pay for anything in Bermuda under my insurance. Nothing! Eyecare covered, baby delivery covered, everything COVERED!

    After a year they insured Nkosi but only after I had forked out over 1000 bucks to get him allergy tested.  Please appeal and see what other options you can do.  Don't let them dictate your babies future.

    Keep us posted and Good Luck.

  • I'm a lurker but saw your post and was pretty upset about it so I asked my husband if he would help you out as a a favor to a fellow nestie and he said no problem-he's  a private practice attorney and deals with insurance companies all the time. I'm sure he could make some phone calls and send a letter on your behalf to get them to approve it.

    Email me at [email protected] and I will put you in contact with him.


  • Please stay on them and take Sonia up on her offer.  I know it seems like a lot of money right now, and it is no doubt, but consider how sad you'd feel if it caused her ears to be un-level.  Even just wearing sunglasses could be awkward....these were the realities we discussed with our pedi as we were trying to decide way back when.  I love that a nestie offered legal help for you.....its just so kind!  Good luck to'll be in my thoughts!!
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  • I just saw the new replies to this and am so touched that a complete stranger would try to help us with this. I will definitely email Sonia. I am always amazed at how supportive this board can be! I hope you meet some of you one day.
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