My Smile Is Medically Necessary. It's Time For The Federal Government To Realize This.
Communal meals, at least in the pre-COVID-19 world, are a big part of the medical profession. We share pastries at morning conferences, bond with colleagues over lunch in the hospital cafeteria and attend an endless series of talks where food is usually provided.
To avoid eating in front of peers and superiors would be to exclude myself from an integral part of my profession’s culture and, some days, entirely miss my opportunity to eat. Instead, I make sure I have a stack of napkins at the ready to wipe my runny nose before anyone notices, and I discretely slip away to blow my nose in the bathroom when I’ve finished eating.
I was born with cleft lip, cleft palate and hemifacial microsomia, a constellation of symptoms that, for me, includes a smaller right jaw and missing right ear. In the past few years, my nasolabial fistula, a common complication of cleft lip and palate, has worsened, and there is now a sizable gaping hole connecting my nasal and oral cavities.
Though my fistula is visually imperceptible, food and saliva slowly seep from my nose during meals. While some foods are more problematic than others, and I am selective about what I eat in front of colleagues, it’s an issue I endure at every meal ― and it can only be corrected through an expensive surgical intervention. Depending on who insures me at the time of the procedure, I could be denied insurance coverage for my care, as I have been many times before. This is especially true now that I am an adult.
Insurers routinely deny coverage for the care of patients with congenital diagnoses, including children. The basis for these denials is that the care is deemed not medically necessary by the insurer, despite being recommended by expert health care professionals on the patient’s care team. The underlying reason is that interventions necessary to care for us, including plastic surgery and dental braces, are considered cosmetic when treating the general population, despite being the...
