If enacted, the ELSA will require all private group and individual health plans to cover services that are medically necessary due to congenital anomalies or birth defects. The requirement would include inpatient and outpatient care; reconstructive services and procedures; and adjective dental, orthodontic, or prosthodontic support.
The bipartisan legislation passed the U.S. House of Representatives earlier this year, and now the ADA is encouraging dentists to contact their senators.
In a November 16 action alert, the ADA said that according to the U.S. Centers for Disease Control and Prevention, 1 out of every 33 children in the U.S. is born with a congenital anomaly. Specialized surgery is needed for many of these children. Yet despite the necessity of these procedures, many insurers consider these services to be cosmetic.
While insurance companies may provide coverage for some preliminary procedures, many insurers delay or deny follow-up or corrective procedures, including dental treatment, which may negatively impact children's developmental milestones.
It is crucial that dentists contact their senator before the end of the year and Congress adjourns. Once the current session adjourns, the bill would need to be reintroduced in 2023, and the process would restart.
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