Puffs the Magic Snack-on

I have found a solution for all of the (baby) world's problems: puffs.

These little flower-shaped snacks are puffed grains that dissolve in your mouth. They come in a variety of flavors, from sweet potato to strawberry apple to cinnamon, and they are typically the first finger food you introduce to babies. My boys adore them, so much so, that the offering of puffs can stop any tears or tantrums.

Mad because your brother took your toy? Try a puff, sweetie.

Rammed your un-helmeted head into the corner of a coffee table? Have a puff, my bruised baby boy.

Upset because I'm leaving the room to do dishes? Let these puffs take my place, darling. Mommy loves you.

Seriously, I have yet to encounter a situation in which puffs did not stop their tears instantly. Just the mere mention of the name "puffs" slows down the tears, and once I spread a handful of the coveted morsels on their blanket, moans, groans, and shrieks are replaced with Mmm's and Num-num-nums.

And while they do not seem to have the same effect on adults (promises of puffs have yet to calm Larry down after a bad golf game), they are magical for most kids. My niece, Woodley, is 2 and had been off of the puffs for over a year when she stumbled on a container of them at my house. She has since come out of puffs-retirement. My nephew, Blake, is 5, and if I leave puffs out while he is over, they have a habit of disappearing. 

I guess I could compare children and their puffs to adults and their chocolate and booze, but let's be honest: chocolate never makes me feel better after I hurt myself and vodka only makes me cry more when dealing with abandonment issues. I think puffs are the ultimate elixir, and we should all petition Gerber to invent an adult version to fix bad economies, natural disasters, and general grown-up woes.

A reverent Grayden admires a single puff.

Okay, United Healthcare, it's on.


I've tried to play nice. I've followed your rules and jumped through your hoops. I've quietly waited for you to do the right thing, but it's obvious you have no intentions of manning up or paying up. The first few rounds may go to you, but I'm coming out swinging now.


UHC will not cover the boys plagiocephaly helmets. The cost is substantial; I borrowed the money for one and we depleted our meager savings for the other. It's a small price to pay, though, when you think about how important the outcome. The helmets not only reform the babies' misshapen skulls, but they also ensure that we will not have to have surgery down the road to correct a number of associated problems, from jaw misalignment to vision disturbances to migraines. 


Some UHC policies cover the helmets but mine has an exclusion in place that denies coverage for "braces that reshape body parts." This exclusion is a stall tactic specifically used to deny cranial remolding helmets. Since the "Back to Sleep" campaign in 1992, more and more babies are presenting with plagio, and insurance companies are looking for any excuse to get out of covering a medically necessary corrective. These helmets are so important that a few states have passed laws guaranteeing insurance coverage. I have no doubt that all insurance companies will cover the helmets in the next 10 years because of pressure from legislatures and large HR departments, but for now, I am left to fight UHC alone.


My 40 page appeal argued seven points:


1. Reconstructive procedures are a covered health service. UHC's own medical policy states "Cranial orthotic devices are reconstructive for the treatment of craniofacial asymmetry in
infants 3-18 months of age with severe nonsynostotic positional plagiocephaly." Therefore, the helmets should be covered by my policy since they are reconstructive. I also argued that the helmets' main function is to reconstruct the skull, not change its shape. It's like covering breast reconstruction vs enlargement.


2. Durable medical equipment is covered. By UHC's definition, cranial helmets fit all criteria of DME.


3. I have the names and addresses of four families with the same exclusion who received coverage in the last year. Why are my sons being discriminated against?


4.  We followed the prescribed course of treatment by pediatricians, physical therapists, and orthotists.


5. Current policies from the AMA, AAP, and FDA support cranial banding.


6. Medical research indicates that untreated plagio can result in much more serious and costly health issues.


7. Cranial banding is the standard of care for plagio.


Each point was explained in detail and supported with photographs, journals, and medical evidence.


Because I had several previous issues with UHC (lost letters and hang-ups when transferring departments), I sent both appeals by certified mail with a return receipt. On the same day I received the return receipt, I also received letters stating that UHC had the appeals and would respond in 30 days. So imagine my surprise that in the same batch of mail was a denial for Grayden's helmet. I was quite confident that they didn't read the appeal; how could they have read and decided on 40 pages and sent a letter in the same amount of time it took the post office to return the read receipt? 


I bit my tongue, though, afraid that any complaint I made would negatively impact the decision on Ren's helmet. I waited 30 days and still didn't hear anything. I finally got up the nerve (and the time) to call UHC and asked about Ren's appeal. The first few people I talked to didn't have an answer for me. It was clear I had made an appeal but not clear what the decision was. Then I was transferred to the "Rapid Resolution Department," the name of which I cannot type without shaking my head.The lady there told me that Ren had been denied and that the letter I received for Grayden was actually for both babies. Funny, since Ren's name appeared NOWHERE on the document but Grayden's was clearly inserted in the form letter in four different places. She knew they had screwed up and used a flimsy excuse to try to get out of it.


So I then asked for my second appeal for both babies, a request that Grayden's denial letter said I could make by phone or mail. Of course, she claimed I could not make the request over the phone and said I had to send a letter. Oh, and are you ready for this? A separate letter for each baby.


I am not a fool. By making me send a letter, they can claim it was never received and I can run out of time before the second appeal request deadline. So I sent these letters once again by certified mail with return receipt.


Now I wait, again. If I worked for a big corporation with an influential HR department, my HR rep could call and put some pressure on, which solves the issue most of the time. But like I said, it's just me. I am sure that doesn't worry UHC, but most people who know me know that I won't let this go. Publicly calling them out on my blog is only my first step (I know that people searching "UHC" "exclusion" and "plagiocephaly" have found this blog). My last is taking a discrimination suit to my state insurance board. Everything in between is just designed to create as much hassle and paperwork for them that they have caused for me.


In Baby News:
We were rescanned on Friday and Grayden is showing great progress. Only 4 to 6 more weeks in the helmet! The red line is his original scan at the end of April; the blue line is from this week:

Ren still isn't growing. You can tell from the scan that the front part of his head is nearly the same size it was in April. When he does grow, the head growth goes in the right direction. He's at least 8 more weeks in the helmet unless we get an amazing growth spurt.

Grayden is now standing! Last weekend he pulled up on Larry once and on a pillow three times. He did it once more on Monday, but then Ren pushed him down and scratched him and that seemed to end his attempts for a while. He regained his confidence this weekend and now he's up all the time.

Both babies had colds and fevers this past week, but are feeling much better now. Unfortunately, the same cannot be said of me. My ex-teacher super-strength antibodies have finally failed me, and I am suffering from lethargy and a sore throat. If that's what I get for kissing and cuddling sick babies, so be it.


EDIT:
At the end of our helmet saga, I learned there is only one way around this exception (besides UHC error and dumb luck): your HR department. If you want to win, just have your HR department call on your behalf. Since my HR department is a one-woman team who was not willing to call, I'm not really sure what goes on in these conversations, but my best guess is that they say something like "We're shopping around for a new carrier for our employees, but before we do, is there anything you can do about Employee X's coverage for a plagio helmet?"


I talked to several women whose children received coverage. When I asked how, they just said "The HR department called." So that's the secret. We're still out $6000 and we still have some major flat heads (was it the Starband or the orthotist?), but I'm learning to live with it.