Washington — The American Dental Association is expressing support for the Ensuring Lasting Smiles Act — legislation that would require all private group and individual health plans to cover medically necessary services resulting from a congenital anomaly or birth defect.
In March 17 letters to Sens. Tammy Baldwin, D-Wis., and Joni Ernst, R-Iowa, and Reps. Anna Eshoo, D-Calif., and Drew Ferguson, R-Ga. , ADA President Daniel J. Klemmedson, D.D.S., M.D., and Executive Director Kathleen T. O’Loughlin, D.M.D., thanked the lawmakers and said they believe the bill will positively impact the quality of life for patients with congenital anomalies.
They noted that one in every 33 children in the United States is born with a congenital anomaly or birth defect that affects the way they look, develop or function and said the Ensuring Lasting Smiles Act is crucial to ensuring that children with congenital anomalies and birth defects are able to receive the treatment they need.
“Many of these congenital anomalies include severe oral and facial defects such as cleft lip or palate, skeletal and maxillofacial deformities, hypodontia (absence of teeth), and enamel hypoplasia,” Drs. Klemmedson and O’Loughlin wrote. “These anomalies can interfere with a child’s ability to breathe, speak and/or eat in a normal manner. Specialized surgery is needed to correct these anomalies. These procedures are reconstructive in nature and are performed to correct abnormal structures of the body.”
Drs. Klemmedson and O’Loughlin pointed out that many insurance companies consider these services to be cosmetic, and while they may cover the preliminary surgeries, they often delay or deny follow-up or corrective procedures, including dental work related to the anomaly.
“This can further delay a child’s developmental milestones,” Drs. Klemmedson and O’Loughlin wrote.
"Passage of [the Ensuring Lasting Smiles Act] would not only help patients with craniofacial anomalies, but would also ensure they have the necessary coverage to restore their ability to function,” the letter concluded. “On behalf of our members and their patients, we would like to thank you for taking the lead on this important legislation.”
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