Lawmakers Reintroduce Bill to Protect Patients with Congenital Anomalies

  • by AGD Washington Advocacy Representative
  • Apr 1, 2021
On March 16, Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA) and Representatives Anna Eshoo (R-CA) and Drew Ferguson, D.M.D. (R-GA) reintroduced ELSA, the Ensuring Lasting Smiles Act (H.R.1916/S.754). ELSA would require health insurers, including ERISA plans, to cover medically necessary services, including dental treatment, for patients with congenital anomalies.

AGD recently sent a letter of support for the legislation and is working with allied health-focused organizations, such as the American Association of Oral and Maxillofacial Surgeons (AAOMS), to have the bill enacted into law.

Most health plans provide coverage for the surgical treatment of congenital anomalies, and many states require insurers to provide coverage of any health services related to congenital anomalies. Despite this, health plans often deny claims and appeals for oral- or dental-related procedures - like orthodontia and implants - which are often crucial to treatment's overall success, claiming these services are cosmetic or covered by dental plans.

Impact on General Dentistry: AGD supports the Ensuring Lasting Smiles Act, as it is critical for patients with congenital craniofacial anomalies to receive necessary reconstructive dental care related to their disorder. These conditions can often exacerbate other oral or systemic health conditions and restrict a patient's ability to breathe, eat, and speak normally. Private insurance currently forces many families to incur significant out-of-pocket costs to access the dental care necessary to treat these anomalies.