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.