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According to a recent CNN article, this could be a game changer for the countless number of families who struggle to afford dental services to correct congenital anomalies and birth defects.

The Ensuring Lasting Smiles Act (S.560), also known as ELSA, has been re-introduced in the Senate by Tammy Baldwin, D-Wisconsin. Previously introduced in the two prior Congresses, the bill never received a floor vote.

If enacted, the bill would "require all private group and individual health plans to cover medically necessary services for any anomaly that requires medically necessary care for any body part that has lost bodily function, including severe oral and facial defects." Ectodermal dysplasia is one example of a condition that would be covered under the new legislation.

Unconscionable Cost-Shifting

Historically, dental insurance companies have disallowed benefits for congenital anomalies and birth defects, choosing to consider these corrective efforts as cosmetic procedures. Families have struggled to afford the out of pocket costs. Arguably, in many cases, treatment was deferred with significant impact on the self-esteem of the children.

The American Dental Association supports the legislation, stating that such anomalies "...can interfere with a child's ability to "breathe, speak and/or eat in a normal manner."

By denying insurance companies the option of disallowing medically necessary treatment, many more children would have the opportunity to live a much more normal and pleasant childhood, as well as a healthier one.

You May Be The First Point Of Contact

Unless your practice is highly specialized, it's likely that your role in creating better lives for these children will be to serve as the first point of contact and source of information.

Assuming that ELSA is enacted – and this is the first Congress in which that stands a fighting chance, at least – you and your front office can walk parents seeking treatment through the referral process and educate them on what the law requires in terms of coverage and payment. 

This should be a "stay tuned" issue for all dentists. There is potentially a lot of good you can do.

Smartbox

Written by Smartbox

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