Policy on Third-Party Reimbursement for Oral Health Care Services Related to Congenital and Acquired Orofacial Differences

Policy statement

The AAPD encourages all third-party payors to design fair benefit plans that accommodate the specific oral health needs of individuals with craniofacial differences. The AAPD encourages policymakers to require and enforce coverage for these medically necessary services.

The AAPD strongly believes in the sanctity of the patient-provider relationship, and the dentist providing the oral health services for the patient determines the medical indication, necessity, and justification for treatment for patients with congenital and acquired orofacial anomalies.

The AAPD encourages third-party payors to

• recognize that congenital and acquired orofacial anomalies require care over the lifetime of the patient.
• include oral health services related to these facial and dental anomalies as benefits of health insurance without discrimination between the medical and dental nature of the defect. These services, optimally provided by the craniofacial team, include, but are not limited to, initial appliance construction, rehabilitative therapy, periodic examinations, and replacement of appliances.
• provide payable benefits for oral health services related to these facial and dental anomalies.