Brenna s condition requires multiple surgical procedures to reconstruct her face to a semblance of normality. I ve had cases where surgery is scheduled and just hours before it is to be performed the insurance company denies coverage. In Brenna s case the denial came two days before the scheduled procedure. Her parents decided to take out a loan to pay for the surgery and risk challenging their insurance company afterwards. Coverage would be required for surgical procedures designed to improve the function of abnormal body structures, or to restore those body structures to a more normal appearance.
Normal appearance is a fundamental feature of healthy human interaction and well being.
These children typically limit their participation in educational and social activities necessary to develop stable behavior later as adults. A child s reaction to ridicule can result in anti-social behavior, including disturbed family interactions, mental instability, substance abuse, and illegal and violent acts. These responses represent lost potential to society and result in an increased tax burden on the country s resources. Insurance companies must do their part and recognize that for a child with a craniofacial deformity, the function of the face is to appear normal. Insurance companies have to realize the impact of their decisions on the lives of these children.