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Anyone else have a child with Brachycephaly?

My son was diagnosed with Brachycephaly. Brachycephaly is basically a flattening of the back of the head. We were told that he needs a helmet to correct it but our insurance company won't cover it. (It's $3800!) My question is: Is this really medically necessary? Our pediatrician told us that his brain will develop normally but referred us to Cranial Technologies. The clinician (there are no actual doctors there) at Cranial Tech says we need to get him a helmet to fix it because it could cause oral and/or auditory problems as well as cause head aches later in life. The insurance company's Doctor says that his condition isn't sever enough to be considered medically necessary under the insurance company's criteria. We have to make a decision soon because there is only a short time frame where this can be corrected before the plates in his skull fuse...

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Heather........

Asked by Heather........ at 9:39 PM on Mar. 12, 2011 in Health

Level 2 (7 Credits)
Answers (5)
  • no , but maybe you can get your pediatriction to make a referrel to your insurance to get it paid for, fight it
    letstalk747

    Answer by letstalk747 at 9:51 PM on Mar. 12, 2011

  • Yeah I would try having the doc call... I don't know if it works the same as perscriptions but If the doc writes me something the insurance company wont cover he'll just call and say it's necessary and they cover it. it's a long shot but could be worth it.
    Finkette

    Answer by Finkette at 9:58 PM on Mar. 12, 2011

  • We are in the process of fighting it. Not sure how long that will take or if it will work... Like I said there is only a short window where it can be fixed. Was just wondering what experience other moms may have had with this condition and what the outcome was.
    Heather........

    Comment by Heather........ (original poster) at 10:04 PM on Mar. 12, 2011

  • I had the SAME problem with my youngest. They weren't going to cover the cost, or even a fraction of it because it wasn't ''severe'' in there eyes, but to ME,...IT WAS! I was a nervous wreck! The doctor gave me a couple months to try and correct the problem, he gave me a list of upper body exercises to do with her, and thank God it worked. Ask LO's doctor alternatives, such as exercises, idk bout your LO but my LO's problem was because she was constantly on her back, and would only turn/look to one side. If LO will need a helmet to correct the problem, FIGHT it, it IS medically necessary, in the long run, it will be worth paying that 38000 bill than tons and tons of bills for LO'S headaches, oral problems, etc.....
    knicole0708

    Answer by knicole0708 at 10:04 PM on Mar. 12, 2011

  • One of my twins had a very mild version, so no helmet needed, We just had to constantly adjust how we put her down and turn her head lots, then increase tummy time when she was awake. I would def have the doc call the insurance compay since he is the one recomending it.
    1plustwinsmommy

    Answer by 1plustwinsmommy at 10:06 PM on Mar. 12, 2011

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