Maysa's Blog

Our journey through plagiocephaly and brachycephaly

Posts Tagged ‘Kaiser Permanente’

Second DSi, on our way to a second DOC band:

Posted by mymaysa on January 20, 2009

We had our appointment at Cranial Technologies today in Annandale, VA. Maysa has been in her DOC band for 11 weeks now.  A second one was approved by our insurance, Kaiser Permanente, and looking at the progress that she’s made thus far, why not go for a second one?  I had really wanted to videotape Maysa’s second DSi and brought my camcorder with me.  My husband had assured me that it was ready for filming.  Well, once I got there, I realized there was no disk inside!  Arrrgh…  I did feel a bit silly!

Maysa did cry during the DSi.  Having that little sock over her head wasn’t her thing, plus, she wouldn’t sit up which made things a little harder.  Her long hair was also hard to tuck in under the sock.  Her sister, Soraya, came with us today and was really good.  She did tell me that she felt sad, though, to see Maysa cry.  How sweet!  Amber and her team got it after a second try and the drama was all over. 

I really liked looking at the comparison between the two DSi.  Her head has rounded out quite a bit (ok, a lot) at the bottom.  The right profile shows it the most and I couldn’t be happier.  The top view also shows that she has gained some length.  Really, this whole experience with Cranial Technologies has been fantastic and so uplifting.

Our fit appointment is scheduled for February 2nd.  Amber suggested that I bring my camcorder (with a disk this time) and that I could record the difference between the two DSi on their computer screen.  I’d love to do that and share it here on her blog.  I’ll just have to make sure that the camcorder IS ready for filming this time.

Today was a good day…

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Kaiser approved our second DOC band. Hooray!

Posted by mymaysa on January 13, 2009

I am so happy; I can’t find the words to express myself! Kaiser Permanente is now covering our second DOC band in full after initially sending us a denial letter in the mail.

Here is the story:

On December 31st, Kaiser sends a denial letter for a second DOC band stating that “insufficient clinical information has been provided to determine if the requested service is medically indicated. Current clinical information that documents Maysa’s history, examination findings including the current measurements pertinent to establishing the medical necessity of DOC banding that reflects the extent of her response to prior treatment, is required in order to establish whether the requested service is a covered benefit and medically necessary. Therefore, A Durable Medical Equipment (DME) item, DOC banding/cranial remolding banding, from Cranial Technologies, Inc., is not a covered medical benefit, at this time.”

The letter also gave the name of the doctor who denied the claim, Dr. Gregory Alexander, his phone number and address.

Another paragraph also states that our pediatrician could call a number to discuss our case and request a reconsideration on our behalf.

First things first, I try to call Dr. Alexander and leave two messages on his voicemail but I never hear back from him. The third time I call, I get him on the line. He explains to me that the reason why he denied the claim is because he couldn’t read the numbers that CT faxed him. He also said that he asked for new copies but that he never heard back from them. I then contact Sandra Vatalaro. She tells me that Kaiser never tried to contact them. She then emails me all the paperwork she faxed them. I print them out and fax them to Dr. Alexander along with the scans of Maysa from Orthomerica. I attach to that a letter explaining things a bit further.
I also contact my pediatrician via email and ask if she would request a reconsideration on our behalf. I also fax her all the documents I faxed Dr. Alexander and then I wait. The letter said that I should receive an answer within 10 days of submitting the request.

Today, 01/13/2009, I get a call from Tammy, Dr. Alexander’s assistant, with the news that after reviewing the documents I faxed them, that the doctor has approved a second DOC band for Maysa.

I am just so so happy, so happy for my Maysa!

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