Insurance Information

Questions for Your Insurance

We highly recommend that you speak directly with your insurance company about the brace that has been recommended. The member services' telephone number can be found on the back of your insurance card and is the best phone number to use. 

When speaking with the insurance company, be sure to ask the following questions:

• Is the code S1040 covered by my policy? 

• Are there any exclusions regarding the code?

• Are there specific criteria that must be met to be eligible for this benefit? (Examples: age, physical therapy, specific diagnosis, etc.)

• What specific benefit category does this code fall under? (Examples: durable medical equipment, orthotics, prosthetics, etc.)

  • Are there limitations or exclusions to this specific benefit category?

  • Does the benefit category have a year or lifetime dollar maximum?

• Is a Prior Authorization, medical review, or pre-notification required for this code?

  • Are there specific requirements due to the cost?

Insurance Considerations

• We will do an insurance verification to determine your coverage.

• Your insurance may require a Prior Authorization (PA) before we can start fabrication. After completing the PA, we will contact you to confirm or modify your fitting appointment.

• Payment of any out-of-pocket expenses will be required before we can release the helmet to you.

"S" Code

Insurance companies identify the cranial remolding helmet through the use of "codes." The code used for cranial remolding helmets begins with the letter “S,” hence it is commonly referred to as an “S” code. It is important that you understand that the S-code S1040 is the code that applies to the recommended cranial remolding helmet for your child.