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 lingo...hm)

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!

My Plagio Baby

Well, well, well.... the day no Momma wants to experience came and I managed to keep living.

Back story: About 3 weeks old, I had crazy freak out day way back, when I was feeding Cade and saw that one ear looked different than the other. I drove him up to my mom's school and had her nurse and coworkers check him out. At the time I thought maybe there was an ear infection. At his month check up I asked the dr about one side of his head that seemed a little flatter. The pediatrician recommended switching sides of the crib when I put him down at night. At his second month check-up she was a bit more concerned about his head shape and recommended being more aggressive about his positioning when laying down or sitting to keep him off his right side. I moved his swing, bought a special Boppy Noggin Nest pillow, and used a rolled receiving blanket to position his head in his crib.

Back to present. On Wednesday we had a consultation appt at Cranial Technologies. They took several pictures from various angles of his head and face. They measured his head and did some neck stretches and diagnosed him with plagiocephaly. Definition: "a malformation of the head marked by an oblique slant to the main axis of the skull." AKA "Flat head syndrome"........Um, did someone use "syndrome" and my baby's name in the same sentence??

It's Greek to me! Plagio = oblique,cephale = head..Check out this image from http://www.cranialtech.com/ According to the site & experts, external forces put pressure on the soft plates in an infant's head, causing them to flatten out on the preferred side.

I've seen babies in helmets before. And no, for the record, I'm not an asshole who thinks the baby is clumsy, the mom drops her kid, or whatev else ignorant fools must think. Okay, I was semi-ignorant and thought the helmet was for a cosmetic issue. I understood. Nobody wants a baby conehead. I went to school with some coneheads and while we didn't tease them, we noticed Oblong Ollie and Elliptical Eddie. kidding.

Turns out plagiocephaly/flat head occurs during utero OR (as my pediatrician says) happy, big headed babies have a preference for one side. Yep, that would be my kid. 90th percentile in head size and happy as hell. The kid knows what he wants, and it's to look at the world over his right shoulder.

I'm camo-ing my feelings by being blase. It's because I want to cry at the irrational mommy thoughts "Does his flat head hurt him? Will the helmet be hot? Will people stop complimenting my gorgeous sweet angel baby? How long will he actually need to be in it? I hope Nick doesn't make it into a Nebraska helmet! Will insurance pay? Arggh!" This is a problem though... Medically having a flat side to your head means that the other side of your head is pushed out. It can result in malformation of the ear tubes, sinuses, jaw, etc. The pictures of him show that the round side of his head is stretching one eye, causing it to be more slanted than the other. (Mommy didn't cheat with the Asian milkman either!...okay, sick joke..I do that when I'm uncomfortable)

So, the clinician predicts that Cade will need to be in a band-style helmet about 8-12 weeks. DOC band, to be precise... there are several types out there. DOC is pretty well rated by parents, and FDA approved as a Class II orthotic. It's a 6 oz plastic shell lined with foam that is custom-fit to each baby. To get fitted apparently Cade gets to be pretty high-tech. There's a head stocking that stretches over his head, takes measurements, and sends it digitally to a printer that prints a 3-D "headsicle" (head on a stick) by which his orthotic will be molded. (imagine the technology Angelina used to get digitized for TombRaider). Hopefully digital Cade is just as cute as real Cade.

Right now we're waiting to see what craptastic teacher insurance will pay for. It's $3,600 for the helmet and the weekly, yes weekly, therapy appointments. (Cade will be evaluated for torticollis-- basically a tight, malformed neck muscle that makes it more comfy for babies to have their chin angled towards one shoulder) After the fitting it will take 2 more weeks for the helmet to made in fabulous Arizona, then he begins his journey towards round head mecca.

I'm hoping the journey is short & sweet & successful! I'm currently searching for cool ways to decorate the helmet. Again, we must not leave it to Daddy lest we have an Aggie baby in a Nebraska helmet. And everyone knows, red and marroon are just wrooonggg.