Baby helmets for flat head syndrome – options, cost, and insurance

baby helmet for flat head syndromeBaby helmets for flat head syndrome – options, cost, and insurance

A diagnosis of severe positional cephaly, be it brachycephaly, plagiocephaly or scaphocephaly, can be so challenging to deal with.  Many parents are unsure how to proceed, and often begin by blaming themselves.  More productive than slipping into a cycle of “is this my fault?” – which is isn’t – is to investigate available treatment options for your child. Children who don’t respond to physical therapy and repositioning techniques are often prescribed orthotic bands and helmets.  This article provides some basic information on the available devices, their prices, and how to deal with insurance dilemmas.

There are several reputable manufacturers and types of helmets to choose from

When your doctor recommends a baby helmet or band, you are able to choose from a wide array of options.  It can be confusing to know which one to choose.  Many orthotics makers began to develop and specialize in these devices after the rise in positional cephalies was noted in the 1990s.  The most popular brand is the STAR family of products, followed shortly after by the DOC band and the Boston Band.  The specialization in orthotic devices had made these companies not only experts in the treatment of brachycephaly, scaphocephaly and plagiocephaly, but also industry niche leaders.  They often work out of their own clinics across the United States, but may occasionally partner with doctors in your area, as well.

The idea behind helmets and bands is the same. While some orthotics refer to themselves as active or passive devices, the differences are minimal. Most available orthotics for positional plagiocephaly are passive devices, or work in a way that sits between active and passive therapy. The only real noticeable difference is a more snug fit on active devices. STARband, STARlight band, STARband bi-valve, STARlight bi-vavle, STARlight cap, the Hanger cranial band, and the DOC band are all “active” orthotics. The Clarren helmet and the Boston Band are “passive.”

Finding a great technician is key

Any of these manufacturers or bands are great and effective options.  Very often the individual cranial orthotic technician working with you and your baby can make all the difference in your experience.  Ideally you should ask for a recommendation from your pediatrician, neurologist, or other specialist you are working with.  That’s how we found my son’s orthotic technician, and he was wonderful.  If you can find someone who has experience with the same clinic, even better.

Cost and treatment time

Helmet or band therapy can cost anywhere from $2300-$4000 and generally lasts 4 months or less. If your child has a particularly severe case, more than one helmet or band may be required. Treatment can be longer for children who start treatment after the optimal treatment window has passed. Some types of orthotics are designed to require the use of more than one device during treatment, others are designed to grow with your baby.

Dealing with insurance companies

Insurance companies don’t necessarily have the best track record where dealing with positional plagiocephaly treatment is concerned. Many parents of children with plagiocephalcy, brachycephaly and scaphocephaly exchange information on on-line forums or chat boards, or through personal websites, to help other parents navigate the red tape thrown at parents by insurers. Make sure that you are aware of the proper ICD-9-CM diagnosis codes, HCPCS procedure codes, and your insurance company’s billing policies regarding flat head syndrome. Ask your orthotic provider what their relationship with your insurer is like, and how much coverage you can expect. This will also give you an idea of what you will need to pay upfront. Billing codes can make a huge difference in the way that an insurance company handles a claim, so keep a close eye, and make sure that all charges are billed appropriately.

If you’ve already filed an insurance claim for an orthotic device, and your insurer has denied you coverage, appeal! Insurance companies aren’t really sure how to approach plagiocephaly, scaphocephaly and brachycephaly yet. The long-term effects of these conditions aren’t well understood, and some companies are providing full coverage, while others treat orthotic helmets and bands as strictly cosmetic devices – letting you foot the bill. Use the resources at your disposal to help you write successful appeal letters. There are many examples on-line, including of law suits which parents have won against insurance companies over coverage issues.

Sometimes appeals processes can be long and drawn out, and the treatment window for these conditions isn’t all that big. If you feel like time is running out, reach out to other funding options. There are non-profits and foundations that work specifically to help parents in your position, whose children have plagiocephaly, brachycephaly or scaphocephaly. You aren’t alone, and your baby will get better.

Always ask about available discounts, for example if you pay cash or in advance.  The cost of my son’s helmet with the advance payment discount turned out to be less than it would have been if we filed for insurance.  In our United Healthcare policy, the 30% covered by insurance was calculated using the full price of the helmet.  The discount I received for payment in full was greater than that.  So be sure to investigate all your options.  Some clinics also offer payment plans that can help with the burden of the cost of a helmet.

 

Comments

  1. Found out my son at 7 months needs a helmet:-( worried about cost and can not afford this. He has Medicare medipass insurance will they cover any of this? I have an appointment set up for next week but not sure If I should go yet if I have no money out of pocket. Please help in directing me if any one knows.
    Thank you

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