The number of children who are denied or inhibited access to care for facial deformities and disfigurement, as well as other congenital defects, is increasing. In fact, in a survey of 703 ASPS members, 53.5 percent of plastic surgeons indicated that they have had pediatric patients who have been totally denied insurance coverage, or have experienced significant obstacles in obtaining coverage for their reconstructive procedures. Unfortunately, too many families are faced with uncooperative health plans obstructing access to care and denying coverage for procedures to correct the problem and prevent long term physical and psychological illness. Dr. Ganske, an ASPS member, provided a giant photo of a one of his patients with a cleft lip to illustrate that these surgeries cannot be considered cosmetic. He noted that the procedure performed was necessary to improve the function of abnormal body structures by returning them to a more normal appearance.
Normal appearance is a fundamental feature of healthy human interaction and wellbeing.
Rep. Kelly, also a widely recognized advocate for patients' rights, reminded the substantial media in attendance that children born with congenital anomalies limit their participation in educational and social activities necessary for normal social development. These children can be subject to long-term physical and psychological problems. Rep. Kelly noted that all children should be given a chance to succeed and TCDA would help bridge the gap for patients and families faced with this issue. Following the statements provided by members of Congress, Susan Hershberg Adelman, M.D., AMA trustee and pediatric surgeon in Detroit, spoke about the AMA's policy on insurance coverage for children's deformities, stating that insurance companies may authorize only one surgery when multiple surgeries are necessary. Dr. Adelman provided the appropriate transition for three families and their surgeons to articulate compelling stories of insurance company delay and denial tactics.