RECONSTRUCTIVE SURGERY: Bill Would Mandate Coverage
Sen. Dianne Feinstein (D-CA) introduced legislation last Thursday that would require health plans to cover medically necessary reconstructive surgery to repair damage caused by accidents, disease or genetic defects. Feinstein's bill would follow the lead of 17 states that already require health plans to cover surgery for children's deformities and congenital defects (Feinstein release, 3/11). Under the legislation, health plans would be required to cover surgical procedures to "improve functions" or "give the patient a normal appearance," however, health insurers would not be required to cover cosmetic surgery to reshape normal body structures to improve appearance(SB 585 text). The bill would apply to conditions such as to cleft lips and palates, burns, skull deformities, benign tumors, vascular lesions, missing pectoral muscles and injuries sustained during accidents. "It has become all too common a practice for health insurance plans to label reconstructive surgery as cosmetic surgery and refuse to pay for it," said Feinstein, noting that insurance companies used to cover such expenses. She said, "That policy made sense then and it makes sense now because these are physical problems, not cosmetic problems" (Feinstein release, 3/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.