"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
About four percent of children in the
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
Click here (https://www.collins.senate.gov/sites/default/files/Ensuring%20Lasting%20Smiles%20Act_Press%20One%20Pager.pdf) to read a summary of the bill.