Legislation Would Mandate Insurance Coverage for Congenital Craniofacial Anomalies

Dentistry Today


The American Association of Oral and Maxillofacial Surgeons (AAOMS) supports the bipartisan Ensuring Lasting Smiles Act, which would require all private group and individual health insurance plans to cover medically necessary services resulting from birth defects.

The act was re-introduced on March 16 by US Senators Tammy Baldwin (D-Wis) and Joni Ernst (R-Iowa) along with US Representatives Anna Eshoo (D-Calif) and Drew Ferguson (D-Ga), who also is a dentist.

The legislation (S 754/HR 1916) would address delays and denials in coverage, including plans regulated by the Employee Retirement Income Security Act of 1974, to ensure patients suffering from birth defects, also known as congenital anomalies, receive the treatment they need in a timely manner.

These treatments could include adjunctive dental, orthodontic, or prosthodontic support. The bill excludes coverage for cosmetic surgery to reshape normal structures of the body to improve appearance or self-esteem.

Many private health insurance companies cover preliminary procedures for congenital anomalies, the AAOMS said, but they routinely deny or delay follow-up or corrective procedures, notably dental-related procedures involving orthodontia and dental implants, deeming them cosmetic or covered by dental plans.

Severe dental anomalies are a common symptom of many craniofacial anomaly conditions, but coverage limits in dental plans aren’t nearly as robust as that of health plans, the AAOMS said. As a result, patients often incur significant out of pocket costs on medically necessary reconstructive dental care related to their disorder during their lifetime, the AAOMS said.

“AAOMS is passionate about advocating for health coverage on behalf of our patients with craniofacial anomalies,” said AAOMS president BD Tiner, DDS, MD.

“We were disappointed that, despite more than 300 bipartisan House cosponsors and 50 bipartisan Senate cosponsors, the 116th Congress did not pass the bill. We look forward to working with the bill sponsors and other patients and provider organizations to get this bill over the finish line this Congress,” Tiner said.

The Centers for Disease Control and Prevention classify birth defects as “common, costly and critical” and reports that one in 33 US newborns suffers from a congenital anomaly. Craniofacial anomalies, or deformities in the growth of the bones in the head and face, can restrict a patient’s ability to breathe, eat, and speak.

Early intervention by a team of specialists including oral and maxillofacial surgeons, plastic surgeons, pediatric dentists, orthodontists, dermatologists, and speech therapists is regarded as necessary to assess and oversee the patient’s treatment and development, often over the course of many years, the AAOMS said. 

Baldwin and Ernst sponsored the legislation in the last Congress. Eshoo and Ferguson were brought on as new lead sponsors in the House.

“As a practicing dentist for nearly 25 years, building better smiles was my career, and it continues to be a top priority of mine in Congress,” Ferguson said.

“The Ensuring Lasting Smiles Act would require all private, individual healthcare plans to cover medically necessary dental services, including reconstructive surgeries that are a result of congenital anomalies or birth defects,” Ferguson said.

“This life-changing bill will give families the opportunity to save for their children’s futures by addressing a loophole that has long allowed insurance companies to routinely deny oral or dental claims for medically necessary treatments,” Ferguson said.

The Ensuring Lasting Smiles Act is supported by more than 30 health professional and patient advocacy organizations, including the AAOMS, the National Foundation for Ectodermal Dysplasias, the American Society of Plastic Surgeons, the American College of Surgeons, the ADA, and the National Organization for Rare Disorders.

Related Articles

Bone Replacement Procedure Successfully Treats Children With Jaw Tumors

Fisher Earns Accolades for Virtual Educational Program

Senate Bill Expands Coverage for Moms During and After Pregnancy