SAN ANTONIO – Ezechiel Carreon is an 11-month-old baby in need of a cranial helmet.
Ezechiel was born with a condition called torticollis, which The American Academy of Orthopedic Surgeons describes as a condition where an infant holds their head tilted to one side and has difficulty turning their head to the other side.
Due to Ezechiel’s torticollis, he only lays on the right side of his head. This is causing that part of his skull to become flat. The flatness of his head is known as plagiocephaly.
His mother, Miranda Hernandez, knows a cranial helmet is needed, but her Medicaid insurance won’t cover it. Hernandez says her insurance says the helmet is cosmetic, not medical.
“I truthfully don’t understand how a child’s skull is cosmetic,” said Hernandez.
Clinical Director of the UT Health San Antonio Cranial Remolding Program, Darren Poidevin says cranial helmets are crucial for infants who need them.
Poidevin says the American Board of Certification defines the term “cosmetic” as when you take something and beautify it.
“We’re not beautifying something. We’re taking something that’s abnormal and bringing it back into normalcy,” Poidevin said.
Poidevin says a cranial helmet works two ways:
- Holds onto the areas that are sticking out
- Build void spaces into the areas where the skull needs to grow into
For Ezechiel, his mother says she is already seeing issues with her son pop up as he waits to get his helmet.
His ears are becoming lopsided, one eye is beginning to close shut and he will need to get hearing tubes put in.
Hernandez says Ezechiel is a twin, and she can see his sister starting to develop faster than him.
“Seeing him try to be as active as his sister and he can’t, it kind of hurts. It breaks my heart because I know he wants to,” said Hernandez.
Hernandez says a helmet usually can cost anywhere from $1,000-$3,000. She was quoted about $2,100 for a helmet for her son, but again, insurance won’t cover it. She says she has called to fight the claim multiple times and even had her pediatrician send recommendation letters for the helmet, but nothing has worked.
“As much as I’ve tried to, you know, contact insurance, they won’t help me, so I feel helpless that I can’t help my own son,” Hernandez said.
Hernandez is not seen by a specialist at UT Health San Antonio, but Poidevin says UTHSA will work with its patients who run into these issues through their Care Credit Program.
The Care Credit Program allows families to finance the helmet over 12 months, with interest deferred.
Poidevin says getting a baby into a cranial helmet when one is needed is crucial.
As babies get older, the brain grows slower and the skull thickens. After 18 months, the skull fuses and a cranial helmet can no longer help.
“Eighty percent of the skull grows in that first year. All this lower part takes about 10 years to develop. We want to get all of this inline, so this follows,” Poidevin said.
Last year, a bill was filed that would have required Medicaid and child health plan program coverage and reimbursement for cranial remolding helmets. The bill passed the House but didn’t pass out of the Senate Committee.
Since Hernandez cannot get the helmet through her insurance, she hopes raising money for her baby will help.