Washington, D.C. – U.S. Senator Susan Collins co-sponsored bipartisan legislation to ensure health insurance coverage for needed treatment and procedures for individuals born with congenital anomalies or birth defects. The Ensuring Lasting Smiles Act would close a coverage gap to make sure that health plans cover medically necessary services related to a patient’s anomaly or birth defect, including any serious dental and oral-related procedures that are necessary to maintain health and overall function.
“I have heard directly from Mainers about the unnecessary hurdles they face when trying to access required medical care for their children. One family from Linneus received a nearly $100,000 bill for dental procedures for their daughter who suffers from genetic anomalies. This is unacceptable,” said Senator Collins. “This bipartisan bill would help to prevent families from facing similar issues by requiring insurance companies to cover medically necessary services, including needed dental procedures, related to congenital disorders.”
About four percent of children in the U.S. are born with congenital anomalies or birth defects that affect the way they look, develop, or function, often for the rest of their lives. Many born with congenital anomalies suffer from severe oral defects (such as cleft lip or palate, hypodontia, enamel hypoplasia), skeletal defects (such as craniosynostosis), vision defects (such as congenital cataracts or aphakia), hearing defects (such as microtia), or other loss of bodily functions. Patients who do not receive timely, continuous care for their congenital anomalies face long-term physical and psychological injuries. Individuals who suffer from ED and other craniofacial anomalies can expect to incur significant out of pocket costs on reconstructive oral and dental procedures related to their disorder during their lifetime
Most group and individual health plans include coverage for congenital anomalies, and many states require insurers to provide coverage of any health services related to congenital anomalies or birth defects. Despite this, health plans systematically and routinely deny or delay claims and appeals for treatment of congenital anomalies by wrongfully categorizing certain treatments or body parts as cosmetic or not medically necessary. This is a common practice across the country and leaves families with the burden of paying for their child’s treatment or procedures that are necessary to restore their ability to function. The Ensuring Lasting Smiles Act would address these coverage denials and delays and ensure that children suffering from congenital anomalies or birth defects get the treatment they need and deserve.
Specifically, the Ensuring Lasting Smiles Act would:
· Ensure that all group and individual health plans cover outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect;
· Stipulate that such coverage include services and procedures that improve, repair, or restore function due to a congenital anomaly or birth defect, including treatment to any missing or abnormal body part that would otherwise be covered for any other injury or sickness. The bill makes clear that this includes adjunctive dental, orthodontic or prosthodontic support; and
· Exclude cosmetic procedures or surgery.
The Ensuring Lasting Smiles Act is supported by a broad coalition of national health care professional and patient advocacy organizations.
In addition to Senator Collins, the legislation is co-sponsored by Senators Tammy Baldwin (D-WI), Joni Ernst (R-IA), Sherrod Brown (D-OH), Lisa Murkowski (R-AK), Amy Klobuchar (D-MN), Roger Marshall (R-KS), Jeanne Shaheen (D-NH), Roger Wicker (R-MS), Sheldon Whitehouse (D-RI), Thom Tillis (R-NC), Debbie Stabenow (D-MI), Kevin Cramer (R-ND), Chris Van Hollen (D-MD), John Boozman (R-AR), Gary Peters (D-MI), Ed Markey (D-MA), Shelley Moore Capito (R-WV), Cory Booker (D-NJ), Lindsey Graham (R-SC), Tina Smith (D-MN), Chuck Grassley (R-IA), Kyrsten Sinema (D-AZ), Jerry Moran (R-KS), Chris Murphy (D-CT), Steve Daines (R-MT), Richard Blumenthal (D-CT), Mike Braun (R-ID) and Jack Reed (D-RI).
Click HERE to read a summary of the bill.