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Petitioning Humana Military (Tricare)

Humana Military (Tricare): Add cranial remolding helmet (DOC Band) to covered services

Our five month old son was recently diagnosed with something called Brachycephaly, a type of plagiocephaly. It is a condition where the back of his skull is flattened, making his head wider. It is something that most likely came from the way he was positioned in the womb. His pediatrician referred us to Cranial Technologies. We were told my son has a severe case and that if it is not treated then he will have to have surgery down the road to correct the damage that the misplaced bones will cause to his jaw. They recommend treating it with something called the DOC Band. The DOC Band is a non –invasive, FDA approved cranial molding helmet that works by applying mild pressure to redirect the growth of their skull to where it should be. It is painless for the child and can correct it in 5-12 weeks. We were happy to find out there was such an easy solution for my son and went home and awaited the call from Cranial Technologies telling us whether or not our insurance company would cover it. We are an active duty Army family, so we have Tricare. Tricare refused to cover any of it. In their policy it says that the only way that they will cover the band is if the child has to have surgery to correct it first. So, basically, they would rather subject a baby to invasive surgery then pay for the band anyway instead of paying for the band to begin with to avoid surgery and paying tens of thousands of dollars for that surgery. Surgery to correct plagiocephaly is only about 30% successful in correcting the abnormal skull shape. The DOC Band has a 100% success rate in most cases and only costs $3800 compared to the tens of thousands that the surgery would cost. Tricare still says no, even if it is medically necessary. Cranial Technologies offered us a discounted price of $2500 that we could choose to split into 4 payments of $625. My husband is a Specialist in the Army and I’m a stay at home mom. We do not have an extra $625 just sitting around, much less $2500. There are hundreds of other families that are in the same situation as we are. If any type of plagiocephaly goes untreated it can result in a high risk for learning delays and developmental delays, increased need for special services when he reaches school age, orthodontic and temporomandibular joint issues, scoliosis, visual disturbances including visual field defects and astigmatism, auditory problems and psychological and social issues. This is something that should be covered by Tricare 100% IF medically necessary. This needs to change. Not only for my son, but for the 1 in 10 children that are diagnosed with plagiocephaly every year.

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