As you might expect, it is difficult to make any definitive statements about insurance coverage, because so much depends on individual policies, coverage, and companies.
Before contacting your insurance carrier, the following documentation will be needed:
- A prescription from a physician
In addition, the insurance carrier may also require this information:
- Proof that repositioning or physical therapy during a prescribed time period was unsuccessful.
Specific measurements and even clinical photographs may also be necessary. To be sure of your coverage, always contact your insurance company before your first visit with an Orthotist! Ask them if your particular policy covers Durable Medical Equipment (DME) and further if they cover billing code S1040. They may say they cover L0100, but that is for a protective helmet, not a cranial remolding orthosis. Cranial remolding orthoses fall under orthotics and prosthetics, which typically is a sub-section under “Durable Medical Equipment” (DME) under most insurance plans. Some insurance carriers will pay for the orthosis if measurements indicate that the baby’s head has a moderate-to-severe deformity and your physician writes a letter stating that a custom cranial orthosis is medically necessary. This letter may also specify whether the deformity was present at birth and highlight potential problems that might occur if the problem is not treated at this time.
If insurance doesn’t cover cranial remolding orthoses, parents should discuss payment plans with the Orthotist and/or Clinician.
Organizations that can help
CARE CREDIT
If you or your organization would be interested in helping us make STARband treatment available for babies in need, please contact us at (877) 737-8444.
CAPPSKIDS
CAPPS will assist you in connecting with the very best specialist and families in your area by putting them right at your fingerprints.
SHARE A SMILE
Share A Smile is a Michigan-based charitable organization founded in 1999 to meet the needs of ordinary citizens struggling with a financial crisis, due to unemployment, health crisis, or natural disaster. We strive to make a difference, one person at a time.
What is Deformational Plagiocephaly? (Flat Head Syndrome)
Learn more about abnormal head shapes in babies.
Tummy Time
Learn more about activities to prevent your child from developing an abnormal head shape.
Meet the AllSTARs!
Learn about the Plagiocephaly experts.
One and Done!
With the STARband, chances are only one helmet will be needed.
Insurance Issues
Insurance issues and what to do.
Will A Baby’s Head Round Out On Its Own?
Learn about Restricted Growth, Unrestricted Growth, and Directed Growth.
Plagiocephaly & Torticollis Awareness: Get the Support You Need for Your Baby
March 20th marks Plagiocephaly and Torticollis Awareness Day. This is a time to raise awareness of these common conditions and work together to ensure babies