Senators Tammy Baldwin and Joni Ernst Introduce Bipartisan Reform to Ensure Coverage for Children Born With Congenital Anomalies or Birth Defects
"Aidan's story has inspired my work on this issue to guarantee that individuals born with congenital anomalies have access to the comprehensive health treatments and coverage they need and deserve," said
"The Ensuring Lasting Smiles Act (ELSA) will close a loophole that has allowed insurance companies to systematically deny claims for medically necessary treatments for our children and families," said
"Those born with congenital anomalies or birth defects should be provided with necessary medical services, and the Ensuring Lasting Smiles Act will help correct a gap in health insurance coverage and relieve the financial burden for American families. It's stories like Allison's that make this legislation so important," said
"Our community is incredibly grateful to our champions
About four percent of children in the
Most health plans provide 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 any oral or dental related procedures- like reconstructive surgery for a cleft palate, under the pretense that such service is merely cosmetic or covered under separate dental plans. This is a common practice across the country and leaves families with the burden of how to pay 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 reconstructive treatment they need.
Specifically, the Ensuring Lasting Smiles Act would:
- Ensure that all health plans cover medically necessary services, including reconstructive surgeries and oral-related procedures, as a result of congenital anomalies or birth defects;
- Stipulate that such coverage include services and procedures that functionally repair or restore any missing or abnormal body part that is medically necessary to achieve normal body functioning or appearance, and clarifies that this includes adjunctive dental, orthodontic or prosthodontic support; and
- Exclude cosmetic procedures or surgery.
A companion bill was introduced in the House today by Representatives
The bipartisan legislation is supported by the
More information on the Ensuring Lasting Smiles Act is available here (https://www.baldwin.senate.gov/imo/media/doc/Ensuring%20Lasting%20Smiles%20Act%20_Release%20Summary.pdf).
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