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
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.
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.
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