The American Society of Plastic Surgeons has announced its strong support of H.R. 1339, the Children’s Access to Reconstructive Evaluation and Surgery Act, which was recently introduced in the House of Representatives.
This bi-partisan CARES Act would require insurance companies to provide coverage for the treatment of a child’s congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease. The bill was crafted in response to the challenges families encounter when insurance companies deny coverage for reconstructive procedures to correct deformities in children.
"The ASPS and CARES Coalition believes that a statutory requirement for insurance coverage of children’s deformities is vital to correct the growing problem of insurance companies denying care on the grounds that the care provided is cosmetic in nature," said Malcolm Z. Roth, MD, ASPS board vice president for health policy and advocacy.
While many states have attempted to address similar issues, state laws do not address families covered by health plans regulated solely by Federal law — typically by large multi-state employers who self-insure and are regulated by the Employee Retirement Income Security Act (ERISA).
According to the March of Dimes, 3 percent of babies born annually (120,000) suffer from birth defects, including cleft lip, cleft palate, and skin lesions, among others. Of the 120,000 children born annually with birth defects, approximately 40,000 require reconstructive surgery.
According to the ASPS, an increasing number of insurance companies are denying access to care by labeling the procedures "cosmetic" or "non-functional" in nature.
A survey of ASPS Member Surgeons showed that nearly 54 percent of respondents indicated they had pediatric patients who have been totally denied insurance coverage, or had faced significant and deleterious obstacles in obtaining approval for coverage of surgical procedures.
Reps. Carolyn McCarthy (D-NY), Patrick Tiberi (R-OH), and Bart Gordon (D-TN) introduced the legislation on March 6.
[Source: Original Press Release]