Understanding Helmet Molding Therapy and Its Cost for Civilian and US Military Families

If you’re the parent of an infant, and you’ve noticed that your baby’s head has an unusual shape, you may have booked the first pediatrician appointment available — and been told your child needs cranial orthosis. For some infants, this treatment becomes a crucial intervention to correct early head shape abnormalities. Cranial orthosis is a safe and effective way to ensure a child’s skull develops properly, alleviating potential future complications.

Here’s what you need to know about this therapy and how to cover its cost — especially if your family has at least one member who is a U.S. Marine or Navy Corpsman.

What Is Cranial Orthosis?

Cranial orthosis, also known as cranial remolding orthosis or infant helmet therapy, is a treatment designed to correct abnormal head shapes in babies. This phenomenon is incredibly common, and treatment often involves the use of a custom-fitted cranial helmet that gently and comfortably shapes the baby’s skull as it grows. The helmet exerts mild pressure on the prominent areas of the skull and provides room for growth in the flatter regions, promoting a more symmetrical skull shape.

Helmet therapy is typically recommended for infants less than 12 months old, as their skulls are still forming and can be effectively reshaped. The duration of therapy varies but usually lasts a few months, with the helmet being worn for about 23 hours a day.

Causes of Abnormalities in Infant Skulls

Multiple factors can contribute to abnormal head shapes in infants:

• Positional plagiocephaly. This condition, also known as flat head syndrome, occurs when a baby consistently lies in the same position, causing one part of the head to flatten. It is often related to prolonged time spent on the back, even though this is the safest sleeping position for infants. About half of all American babies will develop positional plagiocephaly.

• Craniosynostosis. This is a more serious condition in which sutures in a baby’s skull close prematurely, leading to abnormal head shapes and potentially affecting brain growth. This condition requires surgical intervention and may also require helmet therapy.

• Congenital torticollis. This is a condition in which an infant’s neck muscles are tight or shortened, causing the baby to hold their head in only one position, which can lead to skull asymmetry.

Covering the Cost of Helmet Molding Therapy

The cost of helmet molding therapy can be substantial, often ranging from about $1,300 to $4,000. This can pose a significant financial burden even on families with standard health insurance because coverage policies for this therapy vary widely. For military families, the therapy is covered only in very specific circumstances, leaving them with even greater financial, logistical, and administrative burdens.

Private Insurance

Some private insurance plans cover the cost of helmet therapy, but many stipulate very narrow conditions of coverage that may require precise and thorough documentation procedures. For example, for billing purposes, it’s essential that cranial helmet therapy be coded as medically necessary rather than as a cosmetic procedure. You may need to be proactive and diligent about ensuring your baby’s therapy will be covered.

Medicaid

In some states, Medicaid covers cranial orthosis for infants. Eligibility and coverage details vary by state, so it is essential to check with your local Medicaid office.

TRICARE

TRICARE is the government health care program for active-duty service members of the U.S. military, and for many military families, it may be their only form of health care coverage. The problem? TRICARE only covers the cost of a cranial orthotic device if your baby:

• Has craniosynostosis rather than either of the other two conditions that cause skull deformities — even if the skull defect could worsen without intervention

• Has had craniosynostosis surgery

• Continues to have a misshapen skull after the surgery

Why Members of the U.S. Military May Struggle With Helmet Therapy Costs

Military families may have greater difficulty covering the cost of cranial orthosis than civilian ones for a number of reasons.

First, there are the exceedingly narrow conditions under which TRICARE will cover this therapy, leaving the parents of babies with positional plagiocephaly or congenital torticollis with a high medical bill.

Second, even if the baby is eligible for TRICARE coverage, navigating the military health care system and dealing with the paperwork necessary to procure coverage can be time-consuming and stressful for military families.

In addition, military families often face other financial and logistical challenges that can make helmet molding therapy unaffordable, inaccessible, or both, such as:

• Frequent relocations and disruption of care. Military families move frequently, which can disrupt the continuity of medical care for their infants. Finding new providers and ensuring continuity of care can be challenging.

• High costs of living and limited income. Frequent relocations come with significant moving and housing costs, which can quickly deplete a family’s cash flow and savings. Further, moving often makes it difficult for military spouses to find and maintain employment, leaving many families dependent on the single income of the active-duty service member.

• Availability of specialists. As with many other types of specialists, those who provide helmet molding therapy may be located only in certain cities or communities, which may not be reachable from the military base at which families are currently stationed.

Helmet molding therapy is a vital intervention for infants with abnormal head shapes, ensuring their skulls develop properly and reducing the risk of future complications. Understanding the causes of these abnormalities, the costs of therapy that can impact all families, and the specific health care challenges military families face is the first step in advocating for better access to cranial orthosis. By addressing these gaps in therapy coverage and access, we can ensure that every child receives the care they need for a healthy start in life.

Get Helmet Molding Therapy Costs Covered With MC-LEF

Since its inception in 1995, the Marine Corps-Law Enforcement Foundation (MC-LEF) has provided $35,000.00 in educational accounts and humanitarian assistance to the families of active duty fallen United States Marines, Navy Corpsmen, and Federal Law Enforcement Agents. We also cover the cost of cranial orthotic helmets for children of active-duty Marines or Navy Corpsmen. If you’re one of them, and your baby requires helmet molding therapy, contact us to learn how we can help!

To date, MC-LEF has awarded over $93 million in educational accounts and other humanitarian assistance to over 6,000 recipients.

All MC-LEF officers and board members are volunteers; we have only one paid employee. We pride ourselves on running our organization as cost-effectively as possible so that over 90% of our donor funds can be used to accomplish our mission of educating the children of those who sacrificed all. Please consider donating today!