Plastic Surgery for Children and Congress

Cosmetic Surgery Insurance, Plastic Surgery Comments (2)

Plastic surgery coverage for children started back in 2001 when an Arkansas woman contacted her Congressman, Democrat Mike Ross, and asked if anything could be done about getting some help with plastic surgery.

The woman was born with a rare condition known as craniometaphyseal dysplasia (CMD), which was depicted in Mask, the 1985 movie with Cher.

Wendelyn’s constant struggle to get surgical treatment from her health insurance eventually became the Reconstructive Surgery Act of 2003, H.R. 1499. The bill required health insurance firms to provide reconstructive surgery for children born with birth defects. The most common? Cleft lip and/or cleft palate.

Plastic surgeons, along with surgeons who specialize in surgeries of the head and neck, have had years of training in reconstructive surgery.

But, in too many cases, birth defect corrections surgeries are denied by insurance companies and categorized as cosmetic procedures. (Read our previous post about the typical plastic surgeries that insurance firms will cover.)

The bill died in committee, but was brought back to life in 2007 as the CARES (Children’s Access to Reconstructive Evaluation & Surgery) Act, H.R. 1655.

Alas, with passage causing the health insurance industry to shell out much more for surgeries, that bill also died in committee.

Now, Congresswoman Carolyn McCarthy has introduced the CARES Act, H.R. 1339 once again.

Statistics show that about one in 600 U.S. children is born with some type of facial abnormality.

Surgery to repair cleft lip and palate almost always makes a child look much, much better. But left untreated, the defect usually stifles the child’s ability to nurse, chew food, speak normally and live a normal life.

Female breast cancer patients were once in the same position. Fifteen years ago, coverage was granted for removing the breasts, but reconstruction was considered cosmetic. It took an act of Congress, but finally coverage of breast reconstruction after breast cancer is now required by law in the United States.

The current bill is backed by about 15 medical groups, including the American Society of Plastic Surgeons (ASPS), who once took a poll of member surgeons and found 54 percent once had a child patient who was denied coverage for reconstructing birth deformities.

Other groups supporting CARES include The American Association of Oral and Maxillofacial Surgeons (AAOMS.)

Now is a good time to write your Congressperson to support H.R. 1339.

admin @ April 7, 2009