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A Story of Medi-Share and Our Daughter's Cranial Helmet

6/8/2018

12 Comments

 
When our daughter was born, her head had an elongated shape. This type of cone-headed appearance is apparently very common and usually goes back to normal soon. 

At age 3 months, however, our pediatrician said she had plagiocephaly and torticollis. These two difficult-to-pronounce words--indicating issues with head shape and neck movement--weren't what we wanted to hear! But in addition to having faith in God's plan, we were also very glad to hear that these conditions were correctable. We needed to get her a cranial band (sometimes called a cranial helmet, although hers was not a full helmet) that she would wear for a few months. 

The cranial band is a specialized type of treatment requiring advanced imaging techniques and has a very limited number of providers. The best one, from our research, was a company called Cranial Technologies. We drove her three hours to the nearest Cranial Tech location in Orlando where an extremely nice woman named Kristina took measurements. Sure enough, the measurements strongly supported the band. 

Let's skip ahead for a moment and look at a picture of her sleeping outside while wearing her band:


Cranial Band for Plagiocephaly

So all turned out well, but before then something very interesting happened with insurance. 

Cranial bands to treat plagiocephaly are a very time-sensitive treatment. After the baby is several months old, time starts working against you as babies' heads become more set and making changes becomes increasingly difficult. If you know you need to use a cranial helmet treatment, you want to start as soon as possible. 

We were surprised, then, when Cranial Tech told us the next step was usually a 2-week wait for insurance company approval. In particular, they contact the insurance company and try to convince them that the band is a necessary medical procedure. Most insurance companies ultimately refuse to pay for this specialized treatment, but if you just get the treatment when it's needed without prior authorization from the insurance company, then you have no chance of being reimbursed. 

My wife said, "Colin, we drove 3 hours here for a reason. Instead of weeks delay and another trip, let's just call Medi-Share and see what they say."

When I called, a Medi-Share representative was on the line with me in around 90 seconds. She told me that Medi-Share doesn't have any requirement of prior authorization. She believed the expense would be fully eligible for sharing (covered), and although she couldn't give a definite answer without seeing the bill and how it was coded, getting the treatment now we would be just as eligible for reimbursement compared to waiting. 

We told Cranial Tech and they scheduled us in right then. We wrote the first of potentially eight $500 checks and got the first treatment (a comprehensive imaging used to custom-design the band) that same morning. Medi-Share received the bill and contacted us to let us know it was fully eligible for sharing. Not only did they pay the rest of what we owed, but they sent us a $500 check to reimburse our first payment! 

With conventional insurance, we would have faced a very difficult choice. Do we:

(A) Delay a needed treatment for our daughter by weeks, but potentially have insurance pay for it?

OR

(B) Get the treatment right away, but risk paying $4,000 out of pocket unnecessarily?

With Medi-Share, however, we got her the treatment she needed immediately and had the entire process paid in full for us.

Medi-Share was such a tremendous blessing. Our daughter only ended up needing the band for around 6 weeks, which went by very quickly. Now her plagiocephaly and torticollis are cured. When you're a parent, these situations can be very stressful. Having an insurance alternative that really cares about you and your family is invaluable, more so than even the financial savings.
 ​
12 Comments
Tom
7/26/2018 11:17:23 am

Colin, thanks for sharing your story.

Was your wife & new daughter covered by Medishare when your daughter was born?

We are having difficulty with Medishare getting a condition/bills approved for my 2 yr daughter for something she received at birth, before we had Medishare, but discovered & diagnosed after joining Medishare.

Reply
Colin Keeler link
7/29/2018 10:51:40 am

Thank you for your question Tom. Yes, our daughter was a member of Medi-Share at birth, but so long as your daughter's condition was discovered and diagnoses after your family joined Medi-Share, it should be eligible for sharing. (So long as the condition in question generally is.)

If Medi-Share has not already assigned you a Patient Advocate, I would suggest asking to be put in touch with yours and asking him/her any questions you have. Our Advocate, Marlenna, was very helpful and answered all questions.

Please know that your daughter and family are in our thoughts and prayers.

Reply
Kristina
10/4/2018 12:40:15 pm

Hi Colin - thanks for this information. We are currently looking at needing a cranial orthotic. I just spoke with Medishare and was told it would not be covered. Even though it’s DME, it’s in its own category and therefore is not eligible for sharing. I’m just wondering how you were able to have your bill become eligible? Thanks!

Reply
Colin Keeler link
10/5/2018 07:02:40 am

Hi Kristina,

I'm sorry to hear that. Were you told that they couldn't say in advance whether this expense would be eligible for sharing, or that it definitively wouldn't be eligible? If the first of these (couldn't say in advance), then that is what we were told also at first so I wouldn't worry. If you were told it definitely wouldn't be eligible, what specific reason did they give? And were you offered a Patient Advocate for this?

I would like to help if I can so please let me know, thanks!

Reply
Kristina
10/7/2018 06:16:47 pm

Hi Colin - thanks for the reply! So, at first they said it was likely covered, but it wasn’t guaranteed until the bill was processed (obviously). Then he looked a little further and said it was not covered. Honestly, I’ll probably call back, because I wasn’t super confidant in this person. I did have an advocate during my pregnancy — should I reconnect with that person? I also wonder if I made it clear this was something that came about at birth. I didn’t really expect it to be covered since it’s “technically” cosmetic. So, that’s where we are right now. I am going to give them a call again and make sure I was clear and just see what another person says about it.

Kristina
10/9/2018 12:45:06 pm

Hi Colin - Just an update. I spoke with medishare again today. The girl confirmed that yes, they are not covered. However, she referred me to “needyshare” — have you heard of that? She said we would have to apply, but may get some coverage that way. Would love your thoughts! Thanks!

Reply
Colin Keeler link
10/12/2018 09:05:17 am

Hi Kristina,

I apologize for the delay replying. Would you please send me an email (the address is in the sidebar of this blog) if you still need help with this? I can't promise anything of course, but I would be happy to get some more details and then contact Medi-Share on your behalf so we can get to the bottom of this! Thanks.

Reply
Colin Keeler link
11/7/2018 05:00:01 am

Just an update for anyone reading these comments in the future. Kristina and I corresponded over email, and she let me know that after calling in again, the rep she spoke with confirmed that the band "would be eligible for sharing (as much as they can say that until the bill is actually processed, of course)".

If anything changes with the status of these bands, I will definitely update the blog. But for now at least, cranial bands are still an expense that will be generally eligible for sharing as a Medi-Share member!

Reply
Donald Mullen link
11/4/2022 06:16:44 am

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Reply
Lauren
4/16/2024 11:55:18 am

Hi there! Just wondering if you've heard any update about coverage for cranial helmets in the last few years?

My son has been recommended for treatment through Cranial Technologies, but when speaking to Medi-Share I haven't been able to get a clear answer other than ..."eligibility for bills is determined after submission". He did say that likely the 1st helmet would be covered.

Per Cranial Technologies current self-pay contracted rate is $2,400.

Reply
Colin Keeler link
4/19/2024 08:02:04 am

Hi Lauren,

I haven't confirmed in the past few years, but we were also told that eligibility is determined after submission and were then fully compensated. Ask for a patient advocate and they can help you. I hope the process goes very well for your family.

Reply
Grace
7/13/2024 08:34:40 am

Hi Lauren!
We're in the same boat for our son right now. Was the helmet eligible for you guys?

Reply



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    Author

    Hi! My name is Colin. My family and I switched to Medi-Share when we could no longer afford normal health insurance. It has changed our lives and now we want to help others and spread the word.

    Please feel free to contact me with any questions or comments. I will always be happy to help.

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