Insurance coverage

Bipartisan House passes Axne-backed bill to expand oral birth defects insurance coverage

Today, the United States House of Representatives voted 310 to 110 to advance Rep. Cindy Axne (IA-03), Rep. Anna Eshoo (CA-18) and legislation for a bipartisan coalition, the Lasting Smiles Guarantee Actwhich would require insurers to cover dental and oral procedures necessary to treat birth defects.

Currently, many insurance companies deny access to care by labeling these necessary procedures as cosmetic, and denial of these services can lead to long-term physical and psychological harm.

the Lasting Smiles Guarantee Act would close a loophole that has allowed private insurance companies and health plans to deny coverage for medically necessary procedures to treat birth defects.

Specifically, the bill:

  • Ensure that all health plans cover medically necessary services, including reconstructive surgeries and mouth-related procedures, as a result of birth defects or birth defects;
  • state that this coverage includes services and procedures that repair or functionally restore any missing or abnormal body part that is medically necessary to achieve normal body function or appearance, and state that this includes dental, orthodontic, or prosthodontic support for booster; and
  • Exclude cosmetic or surgical procedures.

“There’s nothing ‘cosmetic’ about making sure children with oral birth defects can chew, swallow and talk, and parents shouldn’t face thousands of dollars in out-of-pocket costs for these procedures just because that an insurance company does not deem it necessary”, said representative Axne. “This bill will ensure that children can get the care they need without parents having to choose between medically necessary care and making ends meet, and I’m proud to have worked with my colleagues on this necessary legislative action.

Context:

Rep. Axne has been an advocate for the Ensuring Lasting Smiles Act since hearing the stories of Dallas County, Iowa moms Jennifer Steele and Sarah Ward. Their children, Alli Steele and Amelia and Lucas Ward, all suffer from ectodermal dysplasias, a group of rare genetic disorders where a child’s teeth, skin, hair, nails and glands develop abnormally. The mothers discussed the serious physical and mental problems associated with missing and misshapen teeth, including problems with chewing, swallowing, digestion, speech and self-esteem. Although the Steele and Ward families have health insurance, they are forced to pay thousands of dollars in disbursements because insurance companies refuse to cover medically necessary services.

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