When your child is diagnosed with severe plagiocephaly, brachycephaly, or scaphocephaly, you may be left wondering about the treatment options available. In the most severe cases where physical therapy and repositioning have proven ineffective, orthotic helmets or bands are prescribed. In this article, we’ll review the different types of orthotic devices available, the average cost, and some issues that you may run into if you are considering this treatment, such as insurance.
If your doctor or physician has recommended the use of an orthotic device to remedy your child’s flat head, your options are numerous. Many smaller orthotic companies produce their own devices, although most in the United States now recommend that their patients use the STAR family of products, Boston Band, or the DOC band. These companies have become industry leaders due to their ability to provide customized products at low cost to a large number of patients across the US. They may work directly with your physician or through local clinics. In other countries, different manufacturer options are available.
Helmets and bands work along similar principles. Some individuals choose to distinguish between active and passive orthotic devices – although for many of the orthotic devices available today, the difference between the two is negligible. This is, in part, the result of most helmets and bands being considered passive devices or falling in a gray area between active and passive. The primary difference between the two, as currently viewed, is the snugness of fit. Active devices fit more tightly than their passive counterparts. Self-described active orthotics currently in use for the treatment of flat head syndrome include the STARband, STARlight band, STARband bi-valve, STARlight bi-valve, STARlight cap, DOC band, and the Hanger cranial band. Passive helmets and bands include the Clarren helmet and the Boston band.
Treatment with a helmet or band lasts an average of 2-4 months and the cost varies widely, from $2300-$4000 per helmet or band. Some children will require more than one orthotic device, depending on the severity of their condition and the type of orthotic helmet or band used to correct the deformity. Some designs are intended to accommodate for skull growth and can be adjusted as your baby ages, while others are expected to be replaced as the cranium changes and develops with age. If your baby gets a cranial helmet, they will need to visit the clinic frequently for adjustments, normally every one to two weeks.
Many parents are concerned, and rightly so, about the position which their insurance company takes regarding their child’s condition. Luckily, much of the necessary information is available on-line. In order to prepare yourself for an insurance claim, you can thoroughly research the ICD-9-CM diagnosis codes, HCPCS procedure codes, and billing practices of your insurance company regarding the treatment of baby flat head syndrome or positional plagiocephaly, brachycephaly and scaphocephaly. You may wish to consult carefully with your orthotic provider before proceeding with treatment in order to determine the amount you will have to cover out of pocket, and what their track record has been for collaboration with your insurance company. Some clinics only work with a limited number of insurance companies. Sometimes, the preference for one code over another or the use of an outdated code can cause huge insurance headaches or the denial of coverage that would normally have been provided, which is why it can really help to do your homework.
If you filed an insurance claim for your child’s helmet or band and have been denied coverage because it is considered a cosmetic problem, you can write an appeal letter. The status of plagiocephaly, brachycephaly and scaphocephaly as real medical conditions with long-term health ramifications is still underway. Many insurance companies have faced law suits in recent years, and are beginning to recognize the need to provide coverage for infants and children with these conditions. Look up examples on-line, and contact other parents via forums and support groups in order to bolster your appeal.
Once you have completed the appeal process, if your company still denies coverage, you can re-appeal, or look for other funding options. Additionally, there are some non-profit organizations and foundations dedicated to securing funding for children in need of treatment for flat head syndrome.