Military Insurance Says 'No' to Baby Helmets

Why Insurance Won't Cover Some Claims

In a statement sent to ABCNews.com, TRICARE wrote "… the bottom line is that TRICARE cannot, by law, cover this device until there is reliable evidence to show that both of the following are true... 1) Positional plagiocephaly impairs a bodily function AND 2) Cranial helmets are safe and effective."

Since some of TRICARE's coverage is legislated by Congress, TRICARE says it must follow the law to limit coverage of cosmetic procedures and "we have not been able to find any scientific literature to show that positional plagiocephaly impairs a bodily function -- which makes it hard to document that the helmet actually improves a bodily function," it stated in its release.

However, TRICARE does cover some cosmetic procedures for select scenarios including breast reconstruction, and birth defects. TRICARE did not respond to further questions about whether Isaiah's condition could be considered a birth defect.

Insurance Coverage Looks to Studies to Approve or Deny Claims

"Even if there were literature showing that the natural history of positional plagiocephaly results in functional impairment of a bodily function (e.g., vision), there is still another obstacle to TRICARE coverage, and that is to show that the helmet is proven safe and effective in correcting or improving the bodily function," TRICARE said in a statement.

But specialists who treat plagiocephaly take a different view.

"It's not only for the beautification of the skull," said Peethambaran Ammanath, an orthotist at the University of Michigan Health System.

Ammanath said a few, small studies have linked severe plagiocephaly with developmental delays, and much stronger studies showing untreated plagiocephaly can lead to dental problems because the jaw is not aligned with the asymmetrical skull.

"There could be jaw problems, actually. Sometimes dental problems when the child is older," said Ammanath.

Doctors Say Treatment Works

Dr. Sherilyn Driscoll, director of pediatrics physical medicine and rehabilitation at the Mayo Clinic in Rochester, Minn., acknowledges some studies have shown medical problems resulting from a misshapen skull, as well as problems fitting children into bicycle helmets.

"There's a whole spectrum of how serious this could be," said Driscoll. "But it really is cosmetic and social. That's the main reason to treat it."

Driscoll, however, adamantly disagreed with TRICARE's conclusion that cranial helmets were not proven to be safe and effective.

"It is true that some studies dismiss helmets, but I would argue that those studies have some problems," said Driscoll.

Driscoll said she has heard the argument that parents can fix the flattened skull by repositioning. However, she said if the flat spots are bad enough, it is not practical to fix it with "tummy time."

"At a certain point, if the head shape is severely abnormal enough, that alone would not fix it and that child would need treatment," said Driscoll. "Mom and Dad can't sit there and reposition the baby's head every five minutes."

"The helmets work, there's just no question," she added.

Doctors Say Insurance Often Covers Baby Helmets

Proctor agreed. He recently wrote an extensive review article on the efficacy of the cranial helmets in an April 2009 issue of the Journal of Neurosurgery: Pediatrics.

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