Increasing Insurance Access for Pediatric Craniofacial Patients
Craniofacial conditions include cleft lip and palate, craniosynostosis and craniofacial microsomia, and each of these complex medical issues requires equally complex medical treatment. Full recovery plans often include multiple surgeries, speech therapy and extensive dental work, and parents of children with craniofacial conditions often encounter challenging insurance denial scenarios.
Typically, medical insurance and dental insurance are separate policies that cover different procedures. Unfortunately, many of the treatments that are required for craniofacial patients fall in the gray area between health insurance and dental insurance policies. These treatments are often performed on patients without craniofacial conditions for dental or cosmetic reasons, but are performed on craniofacial patients in order to correct physical impairments and/or as a necessary precursor to additional treatment. As a result, insurance claims are often rejected or labeled as "elective" and children go without the necessary treatments that will help them live full and healthy lives.
Seattle Children's Hospital has one of the largest craniofacial centers in the country; professionals there treated 2,003 children with craniofacial conditions in 2009. Many of the families seeking treatment at Children's are moderate- to low-income and are unable to access medical treatment without full coverage from their insurance providers.
How Washington Appleseed is Helping
Working with Foster Pepper and Seattle Children's Hospital, Washington Appleseed is working to create a guide for parents of children with craniofacial conditions. This guide will explain the rights of individuals within the insurance system, detail how to challenge claim denials to ensure proper treatment and field frequently asked questions about terms and conditions of most insurance policies.
Washington Appleseed hopes to include some practical tools such as template letters and contact tracking sheets to help parents effectively secure insurance coverage for their child's procedures.
Publications
Download a free copy of Craniofacial Conditions and Your Insurance: answers to questions about your coverage, your claims & your child's rights.
Pro Bono and Community Partners
A special thank you to our pro bono volunteers Sven Peterson and Joanna Plichta.