ACPA Family Services

July 2014

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Arizona Diamondbacks Recognize Cleft & Craniofacial Team

Beals

Yesenia and Dr. Beals on the big screen last night at Chase Field.

Last Monday (07.14) the Barrow Cleft and Craniofacial Center in Phoenix Arizona hosted a Girls’ Day Out, treating 12 patients to a day filled with facials, pedicures and hair styling.

A fine story on its own, it got even finer at last night’s Arizona Diamondbacks home game where Barrow and its co-director, Dr. Stephen Beals, were honored with a #HelloHumankindness award.  Accompanied to the field by 16 year old patient, Yesenia, Dr. Beals  shared a bit of Yesenia’s story with the Diamondbacks and their fans.

Cleft and craniofacial teams like Barrow care for their patients in so many ways that reach far beyond the doctor’s office or next procedure. Thanks to Barrow for the creative ways it cares for the whole person and to the Arizona Diamondbacks organization for helping raise awareness about people with clefts and the professionals who care for them.

Learn more about #HelloHumankindness, the Barrow Cleft and Craniofacial Center and the Arizona Diamondbacks.

Got a story about your team’s exceptional care? Please share!

A Good Question: “Will my dental insurance cover braces?”

The short answer is “No.” But your medical insurance probably will.

When we think of braces, what comes to mind? Middle-school? An overbite? Charming-but-crooked teeth?

For many kids with clefts, the use of orthodontia–braces–is an inevitable part of the long-term treatment plan, but not for the usual reasons we think of.

Hestand-Lauren-207x300

Laurena 2014 CPF College Scholarship Recipient, shows off her smile and the sparkle of braces.

When indicated, orthodontic treatment prepares a patient for alveolar bone grafting of the cleft maxilla, for correcting malocclusions and for preparation of jaw surgery. In summary, orthodontic care may include primary orthopedic treatment in infancy and can extend through adulthood. –Parameters For Evaluation and Treatment of Patients withCleft Lip/Palate or OtherCraniofacial Anomalies, p. 20.

Okay, so that’s a mouth full. In other words, for kids with clefts, braces are a familiar tool used for what are probably unfamiliar purposes. And this is the challenge for families: When the treatment plan says it’s time for braces, insurance companies may see the claim as typical orthodontia–braces to help straighten teeth–when in the case of a cleft care treatment plan, it is a necessary part of care without which the remainder of treatment can’t move forward.

As you prepare for braces and the costs associated with them, keep in mind these general tips:

1) Orthodontia for cleft care should NOT be filed with dental insurance. Use dental insurance for routine cleaning and other dental care, but NOT for braces.

2) Orthodontia for cleft care SHOULD be filed with medical/health insurance.

3) Your orthodontist or surgeon should document medical necessity for the medical/health insurance claim.

4) Many orthodontists and surgeons may include their standard paperwork which often features a diagram of the mouth/teeth. Even without reading the details of the claim and documentation of medical necessity, a claim reviewer may deny that claim based on that diagram alone.

Is your family working with Medicaid? In many cases and in many states Medicaid will do a fine job of facilitating orthodontic care within the treatment plan. The bigger challenge is often finding a cleft-specializing orthodontist who also accepts Medicaid.

Whether you are working with private insurance, Medicaid or other resource, your cleft palate treatment team should be your go-to experts for filing insurance claims and communicating with insurance companies about this critical stage of care. An experienced treatment team will have worked through this process many, many times. Allow the team’s experience to help you learn the ropes.

What tips can you share with parents working with insurance for orthodontia?

Treatment Planning: Patients and Families Lead the Way

At the top of your summer reading list? How about, Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate and Other Craniofacial Anomalies. Although the 34-page booklet may not be on your bedside table, the long, difficult title is misleading:  The main characters happen to be your and your family!

Parameters outlines the contributions families make to best outcomes for their children's care.

Parameters outlines the contributions families make to best outcomes for their children’s care.

Combined, the words family and families appear more than 60 times in the Parameters booklet. You didn’t know that someone had written a book about you? Well, it’s with good reason! Patients and families lead the way for successful treatment planning and outcomes. In fact, among the basic principles that Parameters stands on is that:

The team should actively solicit family participation and collaboration in treatment planning. When the child is mature enough to do so, he or she should participate in treatment decisions. (Parameters, p. 8).

There are many great reasons that patients and families become active members of the treatment team. Dianne M. Altuna, a cleft-specializing speech pathologist, educator, and researcher in Dallas reminds us of perhaps the most important reason, “The parent knows their child the best.” Cleft-care professionals know a lot about clefts and other craniofacial issues. Parents know a lot about the child. When professionals and parents bring all that knowledge to the table, we’ve got the foundation for the best outcomes for care.

Dianne shares an example, “When trying to decide upon an imaging study for a younger child (Nasopharyngoscopy or Videoflourography), I always review the two studies with the parents. I ask them which study they think would be easier on their child.”

Another significant advantage to the parent-professionals team model is that professionals manage the long-term big picture while parents focus on what’s next. Why? Treatment planning for cleft and craniofacial care is often a complex, interwoven schedule of interventions spanning many years. It can change and evolve along with the child as he or she matures.  The team manages that dynamic, long-term treatment plan freeing the parent to focus on the many immediate care details and needs.

About the best parent-professional relationships, we often hear parents say things like, “If I have to think about the next 15 years, I get overwhelmed–but I can handle the next six months!” or, “Our team knows what he’ll need when he starts school but I don’t have to worry about that now, I can take care of what he needs in the meantime.”

What’s your role as a member of your child’s treatment team?