Currently, most private 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 systemically and routinely deny, or delay claims and appeals for any oral or dental related procedures. Their “basis” is that such services are merely cosmetic or should be covered under separate dental plans. The Ensuring Lasting Smiles Act (ELSA) would require all private group and individual health plans to cover medically necessary treatment as a result of a congenital anomaly or birth defect. Including dental services, such as cleft lip & palate repair, hypodontia, and enamel hypoplasia. On April 4, 2022, this grassroots bill passed the US House of Representatives with huge bipartisan support with a vote of 310-110. Read about it here:
It is now up to the Senate to pass it through Congress to ensure that the roughly 4% of children born with congenital anomalies can get the coverage they need. ELSA is supported by more than 70 organizations including the ADA, AGD, AAOMS, and many others. The kids that this bill would help need all of our voices. Time is of the essence. If not passed by 12/31/22 in this 117th Congress, all of the countless hours and hard work to get it through the House would be wiped out and it would have to start over from scratch in the next Congress.
The NFED (a personal connection close to her heart for one of our managers, Laura) has created an easy to use tool to reach out to your members of Congress. Please ask your Senators to support and co-sponsor ELSA (S. 754).