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Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

Become a Member
Become a member and receive career-enhancing benefits

Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

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Bulletin Brief

Clinical Updates

January 4, 2022

ACS Comments on the Evolving Challenges of COVID-19 and Nonemergency Surgery

The US currently is experiencing the highest levels of COVID-19 infections since the pandemic began. Although total COVID-19-related hospitalizations have not reached the peak numbers seen in early 2021, the increased patient load and staffing shortages continue to affect the delivery of surgical care. In an NBC News article from late December 2021 that addressed how hospitalizations are affecting all healthcare, the ACS provided a comment on the recent wave:

"The Omicron variant appears to be further limiting operations and other procedures, particularly in hospitals where less than 30 percent of the beds are available in intensive care units."

This comment comes as several states and organizations have acted on or delivered remarks regarding limiting what they consider nonessential, nonemergency operations:

These delays also are driven by staffing shortages, owing to more healthcare personnel staying home to isolate after contracting the more transmissible Omicron variant. Updated guidance from the Centers for Disease Control and Prevention that shorten the recommended isolation and quarantine period after testing positive or displaying symptoms of COVID-19 from 10 days to 5 days may have implications on staffing levels.

The ACS continues to monitor this situation and will keep you informed about relevant information.

Orthognathic Surgery and Inconsistent Insurance Coverage in the US: Update from an ACS Advisory Council

By Peter J. Taub, MD, FACS, FAAP, Chair, ACS Advisory Council for Plastic and Maxillofacial Surgery

Orthognathic surgery is routinely performed for several indications, including:

  • Malocclusion
  • Skeletal facial deformities
  • Masticatory or speech dysfunction
  • Temporomandibular joint dysfunction (TMJD)
  • Sleep apnea and airway defects
  • Congenital or developmental abnormalities and
  • Psychological or aesthetic reasons

Unfortunately, insurance coverage for orthognathic surgery has historically been inconsistent and carries a significant appeals process burden. Recently, the indications for orthognathic surgery insurance coverage across the top health insurance providers were examined. The top 50 health insurance providers in the US were selected using the National Association of Insurance Commissioners (NAIC) 2020 Market Share Report.

To ensure appropriate geographic coverage, the top three health insurance providers per state were included. Coverage policies for orthognathic surgery were obtained from insurers' websites. Coverage was categorized into three groups:

  • Covered with preauthorization
  • Covered on a case-by-case basis
  • Explicitly excluded

Coverage policies and relevant indications and criteria were compared to existing surgical recommendations. It was found that of the 65 insurance providers studied, 33 were classed as "covered with preauthorization," 24 as "case-by-case," and 8 explicitly excluded orthognathic surgery. Five insurers refused to furnish coverage criteria without a member identification number. One insurer's coverage information was internally inconsistent. Orthognathic surgery was always excluded regardless of indication or criteria yet was covered for certain criteria. Five covered orthognathic surgery regardless of indication or criteria, and four guaranteed coverage by CPT (Current Procedural Terminology) code.

Regarding malocclusion as defined by a supplied measurement, 20 insurers used at least 75 percent of an existing standard, eight used the exact standard as coverage criteria, four used a looser set of requirements and four used a stricter set. Fifteen insurers covered orthognathic surgery for the indication of TMJD, while 14 insurers excluded coverage for TMJD. Although 11 insurers covered orthognathic surgery for "any congenital or syndromic condition," 13 insurers covered orthognathic surgery when related to cleft lip or palate-associated abnormalities, and eight covered orthognathic surgery for specific congenital disorders. Surgery for speech abnormalities was covered by 21 insurers and excluded by four insurers. Although sleep apnea was covered by 18 insurers, five different criteria existed; three insurers excluded sleep apnea. No insurance insurer covered orthognathic surgery for aesthetic or psychological reasons.

The investigation highlighted the variable, and at times inconsistent, coverage of orthognathic surgery by US insurance companies. Patient access to information is often difficult, with significant differences across insurance providers regarding coverage indications, strictness of coverage, and exclusion criteria. Often, these criteria do not match clinical recommendations. It is therefore important to encourage the ACS and plastic and maxillofacial surgeon members to advocate for consistent coverage indications and criteria across insurance providers.