Rachel DaVanti was born happy and seemingly healthy, along with her twin sister, Nicole, in April 2010.
Rachel’s parents noticed right away that when she was placed in her crib, she always looked to the left.
They thought it was cute.
“I thought she was looking at her sister because her sister’s crib was on the left,” said her mother, Mary DaVanti. “I didn’t know it was an issue.”
By the time she was 2 months old, Rachel had begun to develop a flat spot on the back left side of her head.
Her doctors diagnosed her with torticollis, essentially a tight muscle on the right side of her neck that was causing her to turn her head. The torticollis contributed to another problem, positional plagiocephaly — her head was developing asymmetrically, with the flat spot on the back.
To treat these problems, her doctors recommended a cranial band, a helmet that would help reshape her growing head.
Rachel’s parents agreed and asked Children’s Memorial Hospital to order the device.
The doctor’s office sought pre-authorization from the family’s insurance company, United HealthCare, which DaVanti assumed was a mere formality.
“I said, ‘I’m sure UHC will cover it,'” DaVanti said. “I thought the plan was really rich.”
Days later, the insurance company responded, saying it would not grant authorization. The helmet, it said, was not covered by the couple’s plan.
The doctor told the family, which lives in the Wrigleyville neighborhood, there was a small window of time during which the helmet would be effective, so Rachel’s parents decided not to wait until they had sorted out coverage with the insurance company.
The couple paid for the $3,029.60 helmet and immediately appealed UHC’s ruling, pointing out that their policy’s Summary Plan Description does not specifically exclude cranial bands. United HealthCare disagreed and denied the appeal.
The couple again appealed. United HealthCare denied that appeal too.
The family then asked for an independent reviewer to rule on their appeal. The reviewer also sided with the insurance company.
“It was clear the independent reviewer did not spend any real time ‘reviewing’ our situation,” DaVanti said. “It was very frustrating.”
Complicating matters was that coverage was provided through a self-insured plan through husband Joseph DaVanti’s employer, Towers Watson. Joseph DaVanti left the company in July 2010.
Still, because it was the company’s money at stake, the couple asked Towers Watson to intervene.
The company refused to override United HealthCare’s decision, leaving the DaVantis with few options.
Convinced the helmet should have been covered by their insurance plan, and worried they would never get reimbursed for the $3,029.60, the couple emailed What’s Your Problem?
“These helmets are expensive,” Mary DaVanti said. “The money is important but it’s more that they bank on the fact that you’re just going to go away. That’s what’s irritating to me.”
The Problem Solver called United HealthCare spokesman Kevin Shermach and forwarded him the DaVantis’ documents that they said proved the helmet should have been covered.
A short time later, United HealthCare contacted the family and said it would pay for the helmet.
“The DaVanti family’s employer made a plan change in 2011 to include coverage for cranial bands to its employee health benefits and will be covering the expenses incurred by its former employee in 2010,” Shermach said in an email to the Problem Solver. “Children’s Memorial Hospital is currently expediting full reimbursement to the DaVanti family, and we are grateful for their patience and understanding as we researched this issue for them.”
Mary DaVanti said she has been told by Children’s Memorial that a check for $3,029.60 should be sent Monday.
“I’m glad we could win this battle, first off because it was a lot of money for us but also because the issue of babies needing cranial bands seems to be on the rise,” she said. “Hopefully, this can help other parents.”
Even better — the helmet worked. Now 2 years old, Rachel has not a trace of positional plagiocephaly.
“She got great correction,” Mary DaVanti said. “She’s doing great.”
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