From WisPolitics.com/WisBusiness.com …
— U.S. Sen. Tammy Baldwin is touting a bill that would require insurance companies to cover more treatments for birth defects, including dental and oral procedures that she says often get denied or delayed.
Baldwin, D-Madison, recently announced she’s reintroducing the federal legislation alongside a bipartisan group of lawmakers. Dubbed the Ensuring Lasting Smiles Act, the bill was first introduced in 2018, according to the release.
The announcement references Aidan Abbott of Slinger, a patient with a rare congenital disease called ectodermal dysplasia whose insurer denied coverage for his dental work related to the condition. His family had “comprehensive” health insurance but had to pay out of pocket for treatment, the release shows.
Baldwin argues “there is no reason” big insurance companies should be able to deny coverage for treatment like this. But she says health plans “systematically and routinely” reject or delay claims for birth defects by “wrongfully” categorizing some treatments or body parts as cosmetic and not medically necessary.
“For millions of Americans, medically necessary care for birth defects can cost thousands of dollars out of pocket, or for others, it is entirely out of reach because of the cost — despite having health insurance,” she said in a statement.
Under the bill, all group and individual health plans would need to cover outpatient and inpatient care for a congenital anomaly or birth defect that mainly impacts the appearance or function of the eyes, ears, teeth, mouth or jaw, according to an overview from Baldwin’s office.
That coverage would have to include care to “improve, repair, or restore function” due to such defects, including treatment that the doctor determines is medically necessary. It covers specific categories such as dental, orthodontic and prosthodontic support while excluding cosmetic procedures or surgery.
See the bill text and see the release below.
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