SPRINGFIELD, Ill. (NEXSTAR) — Insurance companies in Illinois may soon be required to cover all surgeries for facial anomalies and save families thousands of dollars.
One in 33 newborns in the U.S. are born with a facial abnormality, like a facial or palate cleft or missing teeth. These newborns need surgeries to keep up with their developmental milestones for tasks like eating and talking.
Medical insurance companies often only cover the first surgery, viewing the rest as cosmetic. Dave Marsh, director of governmental relations at the Illinois State Dental Society, says it’s because those companies usually are unaware of how the many dental procedures a child with a facial abnormality may need to shape their growth.
“You have to keep augmenting these different procedures by adding and subtracting different surgical procedures as you grow up,” Marsh said. “And then the Medical Review people who aren’t as familiar with the dental aspects of what’s going on many times see this as just cosmetic or are not necessary for the development of the child’s condition and they deny it.”
Lawmakers in Springfield are working on HB4349, which would require by law insurance to cover any surgeries kids with facial abnormalities may need up to age 19. Marsh says families are going broke because insurance won’t cover these surgeries.
“If you don’t have the surgeries, as the child progresses, then there’s ramifications that could be permanent, and cause severe problems and dysfunction to the child,” Marsh said. “So many times they might have to pay out of pocket to wait till they try to get the reimbursement.”
The bill passed the House and Senate with bipartisan support and is now waiting to be signed into law by Gov. J.B. Pritzker.
The Ensuring Lasting Smiles Act, a federal version of the bill, has been filed in Congress by Democrats and Republicans in both chambers, but has gained little traction since being introduced.