Getting An Accurate Price For A Baby Helmet
How Accurate Can We Get?
If you want the quick answer for what a plagiocephaly or brachycephaly helmet should cost then we want you to know it should cost about $2,000.
But if you are one to look at things with a little more detail, then we have to ask you to read on. The truth is that the cost is not that simple. Your costs may vary, that’s just the truth of it. Cost depends on a few things.
Let’s walk through some of these things so you’ll have an accurate picture of what to expect.
The Big Price Determinate
Why Prices Range
First and foremost, it depends on whether you have insurance, what kind of plan you have within that form of health insurance and when / where you are getting treatment.
Your Plan Type and Coverage Levels Matter
When you have insurance, the specialist who treats your child bills your insurance company. If they are in network, they do not pick the price. The insurance company tells the provider what the reimbursement rates are and the provider agrees or does not agree to join the plan.
The provider also uses a special hcpc code to do the billing accurately. An orthotist (custom helmet provider) uses hcpc code S1040 when providing treatment.
Under a very common insurance plan out their today (can’t name names), the cost for a hcpc code S1040 (baby helmet code) is $2,000. Period.
A Baby Helmet For Plagiocephaly or Brachycephaly Should Cost $2000
That’s how we get to the $2,000 amount. Honestly, we have no idea why some blogs or forums have people quoting 3-4 thousand dollars for these helmets. Perhaps the provider billed $3000, as their “usual and customary” knowing that the reimbursment rate is really $2000, and that’s all they get. There is some gray area around non medical blog posts so keep this in mind. (Your on a blog post written by a licensed orthotist, by the way, so you are good!)
Each insurance plan differs a bit. Some plans charge a bit more for the code, and some plans charge a bit less. Plus, your out of pocket costs depend on things like what your insurance plan covers, whether you’ve met your deductible, etc. You might think of it like how restaurants charge slightly different prices in different cities, depending on the local cost of living.
Or, for example if you go to a fast food restaurant chain in city A, the ice cream cone might be $1.00, but in city B the cost is $1.10 even though the name of the restaurant is still the same in both towns.
The Cost Of Your Child’s Helmet, Given The Right Insurance Plan Could Be Free
If you’ve met your deductible, it’s possible the office visit itself could even be free for you. It all ties back to your insurance coverage.
Here’s what you should expect: if your provider is in-network with your insurance plan, they’ll have to abide by the cost of the code in your plan.
When you don’t have insurance, things can vary even more. In fact, some providers even raise the price for people without insurance. Why? Without insurance, you have much more leeway to shop around and compare prices. Providers might think you don’t know the real cost. But, with the facts laid out here, you should have a better starting point.
More ethical providers simply give you the same price they give to common insurance plans. Most will also work with you on a payment plan.
Services Included With The Helmet’s Cost
The S1040 code lays out most of what comes with the helmet. In the description, it says it includes fitting and adjustment.
To get there, you start with an initial visit where the provider sees your child. They usually scan or take an impression of the cranium, with a scan or tangible mold of the child. Then, there’s a fitting and delivery visit for customizing and shaping the helmet. For example, say the plastic is 1/4″ too long over the ear. The provider will trim it down and further customize it to your child’s needs.
Finally, there’s follow up treatment. As we’re sure you know, the child’s head grows. As they grow, you’ll need to make follow up visits. Providers will need to trim padding at the orthotist to give the head space to grow. An orthotist will see the head pressing on the padding, and so they’ll know when to trim.
We hope this information has helped you. If you have any questions, feel free to call us toll free at 1-866-RINELLA.
We have other blog posts on the topic of these helmets so make sure to check those out as well. Good luck!
* Rinella Prosthetics & Orthotics, Inc. is not responsible for any price discrepancies you may encounter. We believe the prices quoted here are very close to what you will expect to see, but if we cannot be responsible for what other practitioners may charge.