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| - Right around 5 weeks I started to notice a flat spot forming on our LO, my husband however thought I was crazy. I had been going to PT as I developed pregnancy induced CT and mentioned it to my therapist, who gave me some helpful tips on at home stretches. The flat spot continued to get worse; therefore, at his 8 MO well baby I brought it up to his pediatrician who confirmed plagiocephaly and referred us to a pediatric PT. The following week, our son was evaluated and found to have not only plagiocephaly but also brachiocephaly; both were believed to be a result of in utero torticollis. Given the severity, she did not believe his head shape and ear shift would resolve with PT alone; even though his pediatrician recommended waiting until 6 months, his PT thought no harm in looking into this sooner. Stretches and PT continued but we were proactive and scheduled a consultation with Cranial Tech at 3.5 MOs. As a parent who has worked in the medical industry for more than 15 years, including billing, I did my homework; I contacted Cranial Tech to obtain the CPT/ICD-9/10 codes, called my insurance company to determine what our responsibility would be based on such codes and inquired to anything further related to prior authorization etc. Our consultation roles around, a few days later a report is received confirming the severity of his "flat spots" and we are given the choice to proceed; my husband and I agreed, absolutely let's be aggressive and start treatment ASAP. With this being said, the billing department submitted all of the necessary information to my insurance company to obtain prior authorization. About a week later, we receive a call from a representative in the billing department who was very thorough and walked us through what we thought was everything; plus, we had already done our homework so there should be no surprises, until he outgrew his band and needed a second one! Our son received his first doc band shortly before the Thanksgiving holiday and was about to outgrow it right before the end of the year. His clinician, Barb, was great throughout his entire treatment; even towards the end when we all thought the chances he would need a second band were high, we were proactive and ready to initiate the process (i.e. images, eval, and obtain prior authorization) before the end of the year so that we wouldn't have to pay the deductible/OOP again. Unfortunately, after much back and forth, the billing department at Cranial Tech informed us that our insurance company is the only company which requires your child be in a doc band for 8 weeks/2 months before s/he can be evaluated for a second band. Go figure, it is the end of 2015 and our child had only been in a band for ~6 weeks. My quam with Cranial Tech is that they knowingly admitted after the fact that our insurance company is the only one that they have seen with this requirement; if that is the case then, why not give us all of the necessary information before we pulled the trigger allowing us to make an educated decision given our situation? We understand that they would never recommend delaying treatment and the sooner you begin the better but at least if we were given that information then, we could've decided if we want to take that chance now or wait until January. As I mentioned, we did our due diligence and went into it completely aware of our responsibility, not a problem, but now our son needs a second band and we don't have the means to come up with the $ for another deductible/OOP just 10 weeks after paying for the first one. Cranial Tech failed to properly educate us as parents, considering they were aware of this one off with our insurance company is very frustrating. This is not a typical question to ask your insurance company, "what if our child needs a second band, do you have any strange requirements". Of course we know that when a new year roles around your deductible starts over; however, our son could've been fitted for a second band in the same year and thus, the need to pay additional funds OOP would've been moot. I will say that the original clinician (don't recall her name) who conducted our consultation did not elude to a possibility of him outgrowing his band in less than 6 weeks either. Ultimately, I would not recommend Cranial Tech to other parents; their prices are more than double their other local competitor and it is the same thing. In addition, they don't proactively provide you with information unless you ask for it. The only positive thing about the experience was his clinician, Barb. His head shape is definitely better but his ear shift is still very pronounced and he could definitely benefit from a second band, just wish we had the means to do right by our son.
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