ASPS Applauds Introduction of Legislation to Increase Access to Reconstructive Surgery for Children

ARLINGTON HEIGHTS, Ill. - The American Society of Plastic Surgeons (ASPS) today announced its strong support of H.R. 1339, the "Children's Access to Reconstructive Evaluation and Surgery Act" - or CARES Act. This bi-partisan legislation was introduced today in the House of Representatives by Reps. Carolyn McCarthy (D-NY), Patrick Tiberi (R-OH), and Bart Gordon (D-TN).

In response to the difficulty families face when insurance companies deny coverage for reconstructive procedures to correct deformities in children, the 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. Many states have attempted to address similar issues. In fact, nearly a decade ago, Texas enacted comparable legislation. However, state laws do not help the many 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).

"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. The American Medical Association defines reconstructive surgery as being performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. Reconstructive surgery is generally performed to improve function and approximate a normal appearance. The CARES Act identifies the distinction between cosmetic and reconstructive surgery.

According to the March of Dimes, 3 percent of babies born annually (120,000) suffer from birth defects. A birth defect is an abnormality of structure, function, or body metabolism present at birth that results in physical or mental disabilities or is fatal. Of the 120,000 children born annually with birth defects, approximately 40,000 require reconstructive surgery.

Examples of these deformities include cleft lip, cleft palate, skin lesions, vascular anomalies, malformations of the ear, hand, or foot, and other more profound craniofacial deformities. Although surgeons are able to correct many of these problems, 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 revealed that nearly 54 percent of respondents indicated they had pediatric patients who have been totally denied insurance coverage, or had experienced significant and deleterious obstacles in obtaining approval for coverage of surgical procedures.

"The CARES Act is common sense legislation that will improve the current delivery system and restore patients' and families' trust and confidence in their health plans. Too many American families are being denied access to health care that would prevent long term physical and psychological injuries. The procedures used to treat these children are, by definition, reconstructive, and should be covered by insurance," said William Huffaker, MD, Chair, ASPS government affairs committee. "Speaking on behalf of ASPS Member Surgeons, we thank the sponsors of this proposed legislation and appreciate their support. As plastic surgeons, we recognize this disparity on a personal level with our young reconstructive patients and their families."