Insurance Authorization issues? -You have control!

For many insurances, Helmets for reshaping are considered "cosmetic".  

They may sit on your authorization if you allow it.   The more information you have, the faster it will process. Companies that make the helmets will tell you that an authorization can take anywhere from 3 weeks to 60 days. (3 weeks being for severe cases). 

I simply could not accept this seeing that Liam was already passed 7 months. When children reach 12 months the skull grows at a significantly slower pace. 

In our case, we have Medicaid for him.  As I mentioned, the more you have, the better.

How to prepare prior the authorization being submitted:

1. Write a letter explaining to the insurance company what steps you have taken to help your child in regards to therapy or exercises at home. Explain how long the flatness has been noticeable. 

2. If your baby is in therapy already, retrieve a copy of the evaluation  from the therapist so that you can provide it for your ortho company. (Save them time.. and give your baby a head start)

3. If you have an appt with the Craniofacial specialist, upon finishing the consult, ask them for a medical necessity document. Explain that you want this process to go through as fast as possible. (Normally the ortho will request it from them, however, remember this, YOU have your ONE baby to worry about. A company has hundreds. )

Keep copies of every document.. and give everything to the ortho company so THEY can submit the documents along with the authorization request.

4. Call the insurance company and find out if they are the ones in charge of the authorization process or if it is outsourced. --From that moment on call 2-3 times a day. -NO SHAME-  Its your baby. 

              -First Call:  Let them know they will be receiving an auth request from the ortho office for your baby's helmet. Let them know that you are aware of the whole process and you have provided every supporting document. And also let them know that you will be calling at the end of the day to confirm if it has been received as well as call to check the status of the process once it is int heir hands.  (no empty threats people- do it!)

            - Second, third, forth etc call :  Call for status. Twice a day it does not matter. You simply call and say  "Hello, Im calling for "childs name" I want to know the status of his/her authorization. ---once they give you the status.. ask again.. when should it be ready? --- and repeat for next call.

If 2 or more days have passed upon your next call remind them that they have all the supporting documents and that your baby needs the helmet immediately as they know "time" is the enemy. 

I did all of the above. Liam's authorization was submitted a Friday morning at 10 am roughly. -- Monday morning I had his authorization number written down. the weekends are not working days.. so this auth was approved in 1 day. 

The ortho company was in shock. 

Knowledge is power.

Understanding Torticollis and positional Plagiocephaly

Torticollis is the shortening of the Sternocleidomastoid muscle, the big muscle that goes from the base of the ear to the collarbone, caused by constriction in the womb or a forceful delivery. The shortened or torn muscle causes the child to look in the direction of the shortened muscle. Without physical therapy it can cause permanent alignment and postural challenges.

The incidence of Torticollis and Plagiocephaly  in babies has risen since the American Academy of Pediatrics initiated the national Back to Sleep Program in 1994. The program was created to decrease the incidence of SIDS, which it accomplished by decreasing the incidence by 40%. Unfortunately, it also created a marked increase in the incidence of positional head deformities in newborns.

When diagnosed at an early age, Torticollis can be decreased by positioning changes and neck stretching. If left untreated in can limit a child’s ability to turn his or her head, see to both sides, hear and interact with the environment. It can also lead to cognitive and motor delays as well as delayed body awareness, muscle weakness and poor balance. Limiting the neck movement makes it difficult and at times painful for babies to be on their tummy which then leads to being on their backs most of the time. And this leads us to “positional plagiocephaly”.

Treatment for Torticollis by an Occupational or Physical Therapist usually consists of family education that focuses on positioning, muscle stretches and exercises. Emphasis is placed on increasing “tummy time” so that pressure on the back of the head is relieved and the baby can learn to move in a more symmetrical manner. Treatment for Torticollis can vary depending on the severity and the age of the baby, and will usually be recommended weekly for 3-6 months. Babies who are treated from an earlier age tend to recover much more quickly that those who are diagnosed after they are 5-6 months old. Early intervention is key.

Plagiocephaly is a condition in which a child’s head is not shaped correctly. Plagiocephaly occurs when there is a flat spot on the back of the head on one side. (Brachiocephaly is an overall flatness of the back of the head.) Symptoms of plagiocephaly are; a flat area on the back or side of the head. The child’s forehead and cheek may bulge on one side, one eye may appear larger than the other, the ear on the flattened side may be pushed forward, and/or the jaw may be tilted.

At the evaluation the therapist will review you and your medical history of pregnancy and delivery and discuss our current concerns. The therapist will assess your child’s neck movement and strength, neck posture in sitting, lying down, on tummy, and supported standing. He will assess your child’s gross motor skills. The therapist will measure the degree of flatness of the head and screen for other diagnosis. If upon assessment the “flatness” is found to be moderate to severe, the therapist will refer you to the Craniofacial specialist if they feel that therapy alone may not be as effective. Where they will then help you decide if you want to go ahead with a helmet- as this is entirely your decision. The specialist will explain the benefits to wearing the 
helmet.

-An important item for consideration during this decision process is the long-term consequences.-

One question you can ask yourself is, “Would I be comfortable with my child’s head shape in the future?” Think about how this decision potentially impacts your child’s future. Can you see them being happy with this head shape when they are 5, 16, 25 and 45?
While there are no clinical studies showing definitive long term side effects associated with an abnormal head shape, there are many studies that are currently looking at a variety of problems.

Physically, the implications can include a wide range of challenges. If the child faces lifelong facial asymmetry, there may be difficulty fitting them with glasses in the future. TMJ or jaw misalignment (i.e., cross bite or under bite) is also something to consider.


What You Can't See
When parents are making their treatment decision, one of the most frequently asked questions is "what effect does this have on my baby's head?" While many doctors originally viewed plagiocephaly as only a cosmetic issue, many now realize that there are structural skull problems associated with plagiocephaly.

The below photo shows a CT scan of a normal shaped infant skull (left) compared to a CT scan of an infant head with plagiocephaly (middle) and an infant head with brachycephaly (right).

What does Plagiocephaly look like?

Here are examples of some of the varying degrees of plagiocephaly. Normal Head shape MildPlagiocephaly ModeratePlagiocephaly Severe Plagiocephaly

If you should decide to have your baby sport the helmet, keep in mind it will just be a few months of your baby’s life that he or she won’t remember, but will thank you later on in life. We are more affected then they are. Always know that you are doing right by your baby!!!

Therapy Sessions & Torticollis

Liam is in therapy twice a week and has been now for the last 2 and a half months. He is being treated for Torticollis ((neck muscle tightening)) This was the actual cause of the Flathead for him. With his neck being tight.. He could never be in tummy time.. it was horrendous for him. Screaming for deal life! Thus, causing him to always be on his back.
((**As SIDS is an issue and they recommend babies sleeping on their backs rather than their tummies.. the best thing to do for them is to re-position them throughout the day.** )) 

The dr said: Just give him time.. some babies don't like tummy time. Even though I would mention that he was stiff and didn't look to the right. ((needless to say.. this Dr has been fired and no longer practices with my ped's office-thank God)

Since he wasn't able to be on tummy time-- he didn't develop the muscles in his back, legs and arms the way he was supposed to. So he has been getting therapy for neck stretching and muscle toning. 

On his first appt... (6 months old) he couldn't roll, lift his head during tummy time (or even stand being on his tummy for 2 minutes), look to the right , withhold his weight in his legs.. or sit. 

He would always have his shoulder very close to his ear.. as you can see here. His face only looks straight because his whole body is slanted here.

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You'll notice in the picture below that his neck has plenty of extension now. Also: he sits and plays without any assistance and rolls like a champ. He wants to stand but not crawl. And even though many children skip crawling altogether.. the therapist wants him to go through each stage accordingly.

And here starts our adventure

This is the Journey of my little football head <3

April 1st Liam got his helmet. Luckily for me... he adapted perfectly!! It doesn't bother him at all!!

The adaption process was smooth:

Day 1 - Wear for one hour 3 times in the day - not for naps

Day 2 - Wear for 2 hours 3 times in the day - not for naps

Day 3- Wear for 4 hours twice this day - yes with nap

Day 4 - Wear for 8 hours straight only.  - yes with nap

Day 5 - 23 hours on... one hour off (for bathing)

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3 days after the 23 hour use... since he has such chubby cheeks he developed a rash. which last 24+ hours ...(The Dr let us know that if the rash lasts more than one hour.. it should be adjusted-- and babies should not be wearin gtheir helmet during this time)

I took him to the appt the next day and his helmet was adjusted.. everything was great after that,

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After 2 weeks of wearing  his helmet: 

The left side is flatter

The bumps on the bottom are from the heads growth already. 

During the first follow up appt, the Dr noted that he apparently had a growth spurt and the reshaping has already begun. Lucky us!!! <3 

::She said that normally they dont see results until 2 months.. so those who dont get results immediately shouldn't worry.. we just got lucky witht he growth spurt.. and my son is already 8 months.. as opposed to the majority who are 6 months. ::

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Note: This week he was sick with high fevers. During the times with the fever we needed to remove the helmet.

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NEXT APPT: May  2nd