Understanding Your Coverage
The vast majority of procedures performed by Dr. Chaiyasate are medically necessary reconstructive surgeries — not cosmetic procedures. This is an important distinction because medically necessary surgery is covered by insurance, while cosmetic surgery typically is not.
Cleft lip and palate repair, craniosynostosis correction, craniofacial syndrome treatment, cancer reconstruction (including Mohs defect repair), and microvascular free tissue transfer are all considered medically necessary by insurance companies and are covered by virtually all insurance plans.
Our office staff is experienced in working with insurance companies and will help you navigate the authorization process. We want you to focus on your health and your child's care — not on paperwork.
What Is Typically Covered by Insurance
Pediatric Procedures
Adult Procedures
Federal & State Protections for Cleft Care
Several federal and state laws protect coverage for cleft and craniofacial care:
Women's Health and Cancer Rights Act (WHCRA)
Requires insurance plans that cover mastectomy to also cover breast reconstruction. This includes DIEP flap and other microvascular breast reconstruction techniques.
Affordable Care Act (ACA) — Essential Health Benefits
The ACA requires marketplace plans to cover pediatric services, including reconstructive surgery for congenital conditions like cleft lip and palate. Plans cannot deny coverage for pre-existing conditions.
State Mandates for Cleft Care
Michigan and many other states have laws requiring insurance plans to cover the treatment of cleft lip and palate, including surgical repair, orthodontic treatment, speech therapy, and audiology services. These mandates ensure comprehensive coverage for the full spectrum of cleft care.
Medicaid & CHIP
Medicaid and the Children's Health Insurance Program (CHIP) cover cleft and craniofacial surgery for eligible children. Coverage includes all medically necessary surgical procedures, speech therapy, audiology, and orthodontic treatment related to the cleft.
Financial Assistance Programs
For families who need additional financial support, several organizations provide assistance for craniofacial care:
FACES: The National Craniofacial Association
Provides financial assistance for non-medical expenses — travel, lodging, and food — for patients and families traveling for craniofacial surgery.
Visit websiteChildren's Craniofacial Association (CCA)
Offers financial assistance for families of children with craniofacial conditions, including help with travel expenses and connecting families with local resources.
Visit websiteSmile Train
Provides free cleft repair surgery for children in developing countries. If you are an international patient seeking care, Smile Train may be able to help.
Visit websiteHospital Financial Assistance Programs
Corewell Health, Trinity Oakland, and Children's Hospital at Troy all have financial assistance programs for patients who qualify based on income. Ask our office staff for information.
Common Insurance Questions
Do you accept my insurance?
Dr. Chaiyasate accepts most major insurance plans. Please call our office at (947) 274-8300 to verify your specific plan. We accept Medicare, Medicaid, Blue Cross Blue Shield, Aetna, Cigna, United Healthcare, and many others.
Will I need a referral?
Some insurance plans (particularly HMO plans) require a referral from your primary care physician or pediatrician. Check with your insurance company or call our office — we can help you determine if a referral is needed.
Will my insurance require pre-authorization?
Many insurance plans require pre-authorization (prior approval) for surgical procedures. Our office staff handles the pre-authorization process for you. We will submit the necessary documentation and obtain approval before scheduling surgery.
What if my insurance denies coverage?
Insurance denials can be appealed. Our office has extensive experience with the appeals process and will work with you to overturn denials. Dr. Chaiyasate will provide a detailed letter of medical necessity explaining why the procedure is required.
Is cleft rhinoplasty covered by insurance?
Rhinoplasty (nose surgery) for cleft patients is typically covered when it addresses functional issues (nasal airway obstruction) and/or is part of the overall cleft reconstruction plan. Purely cosmetic rhinoplasty may not be covered. Dr. Chaiyasate documents the functional component to support insurance coverage.
Is jaw surgery (orthognathic surgery) covered?
Orthognathic surgery for cleft patients is typically covered when there is a documented functional problem (malocclusion, difficulty chewing, speech issues) that cannot be corrected with orthodontics alone. Pre-authorization and documentation of medical necessity are required.
Questions About Insurance or Billing?
Our office staff is here to help you understand your coverage and navigate the insurance process. Don't let financial concerns prevent you from seeking the care you need.
Schedule a Consultation
Dr. Chaiyasate and his team are here to answer your questions and discuss the best treatment options for you or your child.