Pediatric Cranial Helmets
Your Doctor Recommended a Cranial Helmet for Your Baby's Head… Now What?
Over the years our ViaKids Pediatric Team has fit thousands of our youngest prosthetics patients with cranial helmets in order to successfully treat a variety of conditions related to head defects also known as Plagiocephaly. Our team members are not just highly trained professionals with decades of experience in pediatric custom orthotics and prosthetics. They are parents too. Our team completely understands that as parents the process of fitting your child with a cranial helmet can be stressful, scary and confusing for you.
So How Does this Process Work?
One of our ViaKids team members will reach out to you before your child’s first prosthetics appointment. Our team member will verify your insurance benefits and determine if authorization is needed for your insurance plan. If, for some reason we are unable to reach you, the insurance information can be collected and verified at your first appointment. At your first appointment, your child’s measurements will be captured to custom make a cranial helmet via our state-of-the-art CAD/CAM scanning technology. This computerized technology ensures a painless experience, free of the discomforts of traditional casting techniques. The first appointment typically lasts an hour so our certified Orthotist has sufficient time to evaluate and scan your child for a baby helmet.
At this custom orthotic appointment, you also can choose from an assortment of colors and images for the helmet. Our Texas orthotics team can even fabricate a custom design just for your child’s cranial helmet.
After the evaluation and once we receive the insurance approval we will determine if a rescan is needed. Your child’s fitting must be done within 14 days of the initial scan so, depending on the timing of the insurance process we might have to schedule a re-scan appointment.
Once we have current scans for your child, we will pass them onto our fabrication specialists. Our highly trained fabrication specialist will begin building and creating a custom-made helmet for your child. Once completed, we will contact you to schedule the fitting of the helmet. You can expect 7-14 days between the times of your first appointment to your cranial helmet fitting (depending on insurance approval).
Our certified orthotist will work with you and your child every step of the way during the fitting process. Your orthotist will train you how to put on and take off your child’s helmet. They will answer all your questions and share all the information you need to ensure the best results for your child.
We recommend follow-up appointments for our patients. The first follow-up is scheduled after your child has worn his/her helmet for 2 weeks. Generally, all other follow-up appointments will occur every 2 to 3 weeks. However, based on your child’s age child and particular case, your orthotist will determine the frequency and duration of the follow-up appointments to ensure optimal results for your child.
The amount of time your child should wear his or her helmet will be determined in consultation with your physician. Typically, a child will wear his or her helmet 23 hours a day for 3-4 months.
Children may be treated from 3-18 months of age while treatment can be most effective between 3-9 months of age. By following your physician’s and orthotist instructions, a 40-50% correction in cranial vault asymmetry is considered by most to be a success.
There are several different approaches to the Insurance Process…
We understand that the Cranial Helmet experience can be stressful enough for most families, so navigating the insurance information you receive can seem overwhelming. Our team is experienced with most insurance companies and their processes. You can count on us to walk you through every step of the insurance process. We are here to answer all your questions as we go through the process together. Below are some questions our parents frequently ask about the insurance process.
What is Authorization?
Depending on your insurance plan, your insurance company might require authorization. Authorization is the process of obtaining assurance from your insurance company that they will indeed pay for your helmet. This process cannot begin until after your 1st appointment, as all insurance companies require copies of your child’s scans and measurements that are taken at the 1st appointment be submitted with your application. Our highly trained ViaFit team will submit the authorization application for you and they will monitor the status of your application.
How Long Does Authorization Take?
The amount of time it takes for authorization to be approved or denied depends on your insurance company. Unfortunately, this insurance authorization process is totally out of our control. We have found that most of the more common insurance companies can take 1 to 2 weeks to approve or deny authorization (rarely this may take longer if the insurance company is experiencing a back-log in cases).
The Insurance Process
If the insurance company denies the authorization for your child’s baby helmet, we can appeal the denial on your behalf or you may choose the private pay option. We will move forward with you in the appeals process until a final decision has been made by the insurance company and/or you. We can also request additional medical records from your child’s referring physician to submit with our records for the appeals. After we gather all the necessary information and submit your appeal, it may take up to 30 days for a final decision to be made by the insurance company.
Most insurance companies will cover the cost of cranial helmets. We have found there are a few insurance companies that do not cover cranial helmets including Traditional Medicaid which covers post-operative cases only. Please note this is a generalized guide only, and insurance companies evaluate every cranial helmet on a case-by-case basis.
For information about how our pediatric custom orthotic team can help provide your child a cranial helmet, contact us today.