On Monday, the U.S. House of Representatives voted 310-110 to advance Rep. Cindy Axne (IA-03), Rep. Anna Eshoo (CA-18), and a bipartisan coalition’s legislation, the Ensuring Lasting Smiles Act, which would require insurers to cover dental and oral procedures needed to treat birth defects.
Currently, many insurance companies deny access to care by labeling these necessary procedures as cosmetic, and the denial of these services can lead to long-term physical and psychological harm.
The Ensuring Lasting Smiles Act would close a loophole that has allowed private insurance companies and health plans to deny coverage for medically necessary procedures to treat congenital anomalies.
Specifically, the bill would:
- Ensure that all health plans cover medically necessary services, including reconstructive surgeries and oral-related procedures, as a result of congenital anomalies or birth defects;
- Stipulate that such coverage includes services and procedures that functionally repair or restore any missing or abnormal body part that is medically necessary to achieve normal body functioning or appearance, and clarify that this includes adjunctive dental, orthodontic, or prosthodontic support; and
- Exclude cosmetic procedures or surgery.
“There’s nothing “cosmetic” about ensuring children suffering from oral birth defects can chew, swallow, and speak, and parents shouldn’t face thousands of dollars in out-of-pocket costs for these procedures just because an insurance company doesn’t deem it necessary,” said Rep. Axne. “This bill will make sure that children can get the care they need without making parents choose between medically necessary care and making ends meet, and I’m proud to have partnered with my colleagues on this much-needed legislation.”
