Monday, July 6, 2009

Mama Bitch

(Original title: Mama Bear, but listening to "soothing" music while on hold with insurance company facilitated my edit)

You know some days you wake up, read the horoscope, and wonder to yourself "WTF is that supposed to mean?" You make some predictions in your head and you go about your day. Then, like Matt Lauer hitting the deer, BAM! It hits you and you think "Right on, Google horoscope guru!" (This hold music is taking forever...hence my long intro)

I was informed today by Cranial Technologies that my insurance, Cigna, has a fancy little EXCLUSION on it that allows them to deny coverage for Cade's $3,600 Dynamic Orthotic Cranioplasty (DOC band). I was warned by parent groups online that insurance carriers have a tendency to dub plagiocephaly/brachycephaly (yup, Cade's got a dual diagnosis) as a cosmetic procedure. I haven't heard those 2 words uttered by Cigna reps on the phone yet (again, still holding). Instead they are saying that they will only cover the DOC band and therapy AFTER my newborn has skull surgery. Um, wtf?

One would think that a $3,600 head mold and weekly therapy (included in cost at Cranial Technologies, making it stand out as the better choice among every plagio support group online) would be cheaper for the insurance company. As one parent on a support site puts it, "It seems my insurance company would allow me to break my child's skull, then they'd cover the therapy. It's criminal and illogical."

Putting aside the whole "cosmetic" argument (obviously you don't want your baby to have a deformed head, assymetrical eyes and cheek bones, ears, and ears that protrude), how can they say it's not medically necessary? I don't need to convince you, my online friends, but the clinicians and multiple sites I've researched state that untreated plagiocephaly can lead to migraines, ear infections, sinus infections, TMJ, and for sporting helmets to not fit in later childhood and adulthood. It's crystal clear to this Mama Bear!

(Finally off hold, the fine lady at Cigna acted like she's never heard of this before, when the first rep I talked to completely knew the cranial

My next step is to get my pediatrician to call in a pre-authorization and send a letter of medical necessity. Turns out the nurse just told me that they already have these form letters ready to go for the various insurance agencies that turn it down. Positional plagiocephaly (caused by external forces such as crib beds putting pressure on the skull causing it to flatten in places) is on the rise 60% since the Back to Sleep campaign to put babies to sleep on their backs to avoid SIDS. The pediatricians are aware and mine was on her game when she started giving me repositioning tips to avoid flattening from month 1...If only the insurance groups would catch on. It's sick and horrible that insurance companies make you jump through hoops to get this coverage, when other parents may not take the time to fight for it and their child doesn't get the orthotic and therapy.

** You know, one parent online said that she'd rather pay the $3600 for the DOC band than buy a headstone for another child she could have lost to SIDS. ** It breaks my heart that you try your best to do right by your child and people have to stand in the way.

Here's the horoscope I referenced at the beginning of this entry.

"You might feel as if you are the only one who can clearly see what's happening today. This may encourage your stubbornness as you attempt to navigate yourself and others through a complex minefield of obstacles, some real and others imagined. But you could make a crucial error in your thinking if you start out with the assumption that everyone else is wrong. Incorporating multiple points of view into your perspective will strengthen the foundations you are now building."

As always, when faced with a tough situation I'm going to do my research, get it all organized, color-coded, whatever I need to do and be my own lawyer and fight for what's right. Watch out, world....Mama Bitch is ON!

1 comment:

  1. HILLARY!! It's Amy (from Islands' and Heather's fried) Oh my goodness, we are going through the same thing!!! We went to Cranial Technologies and have to get the band too, and Cigna won't pay a cent for it! I have already e-mailed all of the news station for help. E-mail me!


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