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July 2011 Moms
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DoubleOMommy... ? for you

MamaCoffinMamaCoffin member
in July 2011 Moms

A friend of mine has a 5 month old daughter whose OT recommended she get a helmet. She has a serious flat side and her neck muscles are messed up because of it. She explored her helmet options (which are no less than 2 grand) and submitted a request to her insurance. THEY DENIED HER REQUEST! They claimed it was for "cosmetic reasons". I call BS if you ask me.

You don't have to get too personal on here but I was just curious what your experience was with this. I'm hoping maybe she can appeal it and get some better results. Do you have any advice?


Mama to two perfect little girls.
Lucy 07-13-11
Violet 03-13-14
Conceived #3 since September 2015
11-25-15 twelve week loss
07-21-16 ten week loss
10-03-16 5 week loss
TTC again soon!
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Re: DoubleOMommy... ? for you

  • heedy07heedy07 member

    I know this wasn't directed towards me, but DS has been in a helmet for the past few months.  It was $2500 and our insurance told us there was no way to get it covered, because it is cosmetic (which it technically is).  They told us that there are still a few companies that will cover it, but for the most part, you will have to pay out of pocket.  For the record, it was worth every penny and I totally reccommend Bling Your Band (find them on facebook) personalized decals to decorate it :) 

    K, born 05/06/10 B, born with a few surprises 07/20/11  

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  • doubleOmommydoubleOmommy

    My son's insurance covered it 100% thankfully. I have heard of many people appealing it and winning though. If she can get her pedi to write a referral stating that it is medically necessary for the baby to have a helmet(the neck issues are a big one) it will be hard for them to not approve them for at least some assistance with the cost. There are so many issues that can happen later in life if the problem isnt solved as an infant such as jaw issues(TMJ), hearing problems(from the ear canals being squished) and many more. I hate that they call it "cosmetic"... ugh. Sorry I dont have much experience dealing with the insurance but I would direct her to the DOC Band facebook page. There are TONS of talk about appealing insurance as well as lots of other great info. I hope she can get it covered! Good luck! Here's the FB page:

    https://www.facebook.com/#!/DOCBand

     

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  • AmandaP678AmandaP678 member

    WOW that's horrible that insurance companies would deny something as (in my book) serious as that

    I wish your friend the best of luck!

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  • katie4253katie4253 member
    Most insurance doesn't cover it unless there is jaw or ear canal involvement.  This is very common and the reason we were so glad p/t worked for his flat head. 
    Born at 31w3d due to severe IUGR & Placental Insufficiency--2lbs 3ounces
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    We'll miss you sweet Debbie Girl (4.21.12) and sweet Cindy Girl (8.9.12)
    Lilypie Premature Baby tickers

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