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Craniofacial Surgery Medical Insurance Questions

Important Information in Regards to Insurance Coverage for Cleft and Craniofacial Operative Procedures

Having a child born with a congenital syndrome can be trying for a multitude of reasons, health care being first and foremost.  Children born with a syndrome such as a Cleft Lip and Palate, Apert, Treacher Collins, Crouzon, Pierre Robin, Pfeiffer, or most common, various forms of  Craniosynostosis,  are typically provided with Medicare/Medicaid.  However, this does NOT guarantee coverage.  Many states like Tennessee (Ten-Care), and Georgia (Georgia Medicaid),  have their own in-state plans that require in-state treatment by doctors who operate within the state and are registered with Medicaid/Medicare in that state.  Having the choice of the surgeon and care providers you want can be restricted by each states individual policies. 


It is important to check if your policy applies is accepted by both the hospital and doctor of your choosing prior to scheduling an operative procedure.


If you carry private insurance like Blue Cross Blue Shield, Aetna, Cigna, Select Health, United, and others, this is typically not recognized as the PRIMARY insurance carrier for these deformities.  Medicaid/Medicare will be billed first and then the secondary carry is billed.  This can still leave you with a balance owed to the hospital and doctors.  This is called "Balance Billing" and often is in addition to your deductibles. 

Checking with your insurance carrier(s) is a priority before engaging the doctor of your choice. 

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