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.
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.