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Hi. I'm Karen. I was just referred to this forum by a friend on another forum. I never knew this one existed, or I'd have been here long ago. My husband has been in the Army for 17 years, and we've been married 13 years. He is in the middle of his second year long tour in Iraq, and hasn't even seen our newly adopted son. We adopted our only child, a baby boy, from Guatemala, and after bringing him home last month I took him the very next week for a wellbaby checkup. The doctor immediately said he has severe plagiocephaly which I was clueless about at that time. She said she would referr me to a specialist for him, and my head was swimming. Then she told me that Tricare will not cover the cost of his treatment. I was confused of course. I thought tricare covered everything. Well, come to find out Tricare considers the treatment for plagiocephaly to be cosmetic and experimental. However, without treatment the specialist said Caleb would have to have major reconstructive intrusive skull and facial surgery as a toddler if not treated now. Basically the back of his head is malformed and flatted on one side, and his brain is growing and pushing to the left which will eventually cause facial malformations and other medical problems including eyesight, hearing and other things. I thank my lucky stars we are catching it before he got any worse, but my problem now is that Tricare will not cover the cost of his treatment. My husband and I are maxed out on adoption loans already and cannot afford much. We are doing what we can, and put Caleb's helmet on a CC that we can't even afford. Now we have to come up with the rest of the payments and still have to pay the CC, and on top of all of that we have had MANY trips to the doctor which is eating up our gas and is a huge expense with the gas prices so high. I'm at my whits end trying to find help for paying the medical bills. I've tried the following so far for help: local media, shriners, Children's Miracle Network, Medicaid, KCHIP, First Steps (for his therapy), and a long list of other places to help with our medical bills. According to other military families that I've talked to who have already put up a fight to have their baby's plagiocephaly covered they have not won even after going as far as the Congressman. I don't know where to turn at this point. Caleb, our son, needs this treatment but its breaking us at the bank. If there is anyone at all that has information that could help me get the medical bills covered, I'd be so grateful. I'm hoping someone will know of grants for military children or anything. I have heard AER gives medical grants, but they won't talk to me till I have a POA in hand. The US Embassy in Guatemala kept my original POA, and for Dave, my dh, to get a new one in Iraq he has to get permission to fly to another base to be able to get a new POA which is dangerous and he probably won't get the permission to do that. He's going to try, but said it may be something he'll have to look into doing himself at AER after he comes home for his 2 week leave in June or July. If you've managed to read the whole message, I thank you, and if you have information that could help me I doubly thank you. Here's a couple pictures of our baby boy that I love so dearly. He's the absolute joy of my life, and he thanks you too for helping mommy find some help to pay for the medical bills. Thank you so much for any information! Karen
Hi Karen,
I think we emailed before, when you were first starting your adoption. I am so glad you have your son home. we also adopted from Guatemala and came home to Germany last August.
I am so sorry you are going thru this. we have been there too. did they actually do measurements on your son's head for asymmetry??
our little boy also has placio but, without any asymmetry (facial change) we went thru the peds doc and then had the measurements done by EDIS (he was also evaluated for delays...not crawling or rolling) but, within 2 months he was fully caught up and is now almost 18 mos is a running little boy :)
we also went around and around about what to do....our case would be considered cosmetic (he is flat on the very back of his head). I did look into it and we tried to get the helmet here locally in Germany but, once again we were 'chasing our tails' so to speak and long story short...the only dr near us was over 2 hrs away and of course tricare would refuse converage, especially because our peds dr. said he was fine and by then he was almost 10 months old and some docs will not band/helmet after 12 mos....but many others in the states will :(
our son's hair is much thicker now and it not to noticable (unless you rub the back of his head, of course)
your case sounds very serious...here is a great yahoo group I joined for placiocephaly
[url]http://health.groups.yahoo.com/group/Plagiocephaly/[/url]
post your message there...I believe there are acouple families on there that got Tricare to pay!!! but, their cases were also severe like yours (facial changes, etc)
let me know I can find the military person I spoke to that got Tricare to cover (they were on that yahoo group, someone from the group emailed them for me)
also for grant info...are you on the yahoo military support group? the moderator is Barbara Burke, she is wonderful and can probably point you in the right direction. here is the yahoo group site
[url]http://groups.yahoo.com/group/AdoptionSupportGroupForMilitaryFamilies/[/url]
with the severity of the placiocephaly I would not delay on his treatment, especially if it is pushing on his brain and causing facial changes. did they recommend banding/helmet for him or is surgery the only option? I would demand Tricare to cover!!! even if you pay now and fight it out later...get his treatment started ASAP.
I did not fight because our little boy's head was not causing him health issues.
good luck and email me if you need more info!
Chris
p.s. your son is so cute!!!
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Hi Chris, I'm assuming you mean in Guatemala about the asymmetry question, and the answer is yes. Only the doctor there did not disclose it to my agency or I. His reasoning was it was normal for babies to have mishaped heads.
As for Caleb's type of plagiocephaly, his current doctor said it would only continually get worse. One of his ears is larger than the other from laying on it the first 4 months, its also lower to his shoulder and closer to his nose than the other ear. His doctor said by the time he's a year old he would have facial malformations, and would need major corrective surgery on his skull and face if not treated now. As it is he needs surgery to pin back his larger ear a bit to make it less noticeable, but that won't happen till he's about 4 or 5 years old. I have already moved forward to get his treatment, and put his helmet on a CC we can't afford. His doctor was so concerned he had me an appointment with the helmet place the very next day. So, in one week alone Caleb had a CT Scan, saw his 3rd doctor who is going to see him throughout the treatment, and was casted. We've just been waiting for his helmet to come in. They are testing his hearing tomorrow.
I already tried the yahoo group and have been posting there. Everyone there has said they haven't been able to beat tricare. Some have even gone to their congressmen and still tricare wouldn't budge. I'm going to do the same just so I can add my name to the list of families in the hopes that someday it might make a difference. I have three doctors who have all seen our son and said he has severe plagiocephaly. It's far from a mild case, and is going to progressively get worse without the treatment. Luckily the helmet will arrive this week and we will pick it up on the 25th. So, we can finally start his treatment.
I will see if I can join the military yahoo group and see if anyone there can help. Crossing my fingers Barbara will have ideas. I did find out one bit of information from an Air Force family who fought tricare and lost. They said they ended up going to the air force emergency relief program and got a grant to pay for their child's treatment. I'm going to try the army emergency relief program, but have to wait for my husband to come home from Iraq. The US Embassy kept our original POA in Guatemala and AER needs it. My husband can't get a new one without flying to another post in Iraq, and said it would be better to wait till he comes home for his 2 week R&R leave. We have about a month or so till he comes home for that and we'll try AER for a medical grant. I'm praying it will come through for us. Thank you for all your help. I'll try the military yahoo group next. Thanks, Karen
Karen,
As being former ARMY brat and being in the ARMY myself for 4 years i know the system a little better than most. As fas as tricare goes yes they are a pain in the RUMP. I take it that you have done the proper chain and have going to a military peditrician and have gone to all military doctors not civilians. the reason why tricare has a tendancy to fight is because it is in the civilian sector. trust memy son had a hearing test done at children;s hospital in Columbus ohio it took 3 years to get it approved and at the time my husband was still active!!!!
if you have not gone to military hospital I STRONGLY URGE you to do so. When you do make sure you get the highest ranking person there. If he agrees with the diagnosis he can take it to the commitee to approve for surgery. if you have already gone to the military doctors i have found from experience that if you want something done quickly you narch you little butt straight into the post commander's office. ALL post commanders have a open door policy. AND trust me they do not like spouse's to have issues so bad that they have to go to the general. I would raise as much stink as possible until you get a answer that you like
Paula
Thank you for the reply Paula... The first doctor was the on post army hospital doctor. She's a CPT, and she's the one who first diagnosed our son. She immediately said he needed to see a specialist, but there on the spot she also told me tricare wouldn't cover the treatment. She thought he was going to need surgery because his plagio is so bad. So, I went through the military channels first. Went to a military doctor and then was referred off post. I first saw a neurosurgeon who said his plates were still open and he referred me to a plastic surgeon. Nearly two months later he's finally getting his helmet this week, but out of our pocket. Tricare wouldn't pay. I'm hoping AER will come through for us, but we have to wait till dh comes home. He'll raise a stink for sure because he's devoted 17 years of his life to the military. 13 of those we've been married and he's been gone for about 7 of those years always deployed somewhere. Belgium, Bosnia, twice to Iraq, and did so many other deployments and trainings I've lost count. So, he feels tricare should pay for it after all he's fighting for our well being. I pretty much know tricare won't budge by what all the other military families have told me that have been through this already, but I have hope that AER will give us a medical grant. I've tried every other organization I could think of. A list as long as my arm. Ronald McDonald House, Medicaid, KCHIP, Children's Miracle Network, and the list just keeps going... Thanks for trying. Karen