The care of cleft lip/palate, as demonstrated in our “About Cleft Lip/Palate” section, often involves treatment that occurs at different stages of development over time. It also involves multiple providers from various medical and social specialties. Coordinating the care is just one part of the package; successfully managing the insurance needs of the patients is an aspect of care that can be confusing and, at times, frustrating. This page hopes to help prepare patients and families for dealing with insurance issues.

Patients with AHCCCS or KidsCare Insurance Coverage

Arizona’s children with a cleft lip and/or cleft palate AND coverage with any of the state’s Medicaid (AHCCCS) or KidsCare plans qualify for coverage of care under the Children’s Rehabilitative Services program.

This program pays for all aspects of cleft care as long as the patient maintains financial eligibility and enrollment in AHCCCS. If your child has a cleft and has AHCCCS or KidsCare coverage, you can download an application or call the Children’s Clinics at 520-324-5437.

Patients with Commercial or Private Insurance Coverage (United Healthcare, Blue Cross/Blue Shield, etc)

The Children’s Clinics accepts most commercial insurance plans. If you would like to enroll your child with a cleft lip and/or palate with the Cleft Care Team, simply call (520) 324-3046 and speak with the coordinator, Colleen McHugh, LMSW. The Children’s Clinics also accepts self-pay patients for care.

Dental Insurance

The Children’s Clinics does have dental and orthodontic clinics to provide care for children with a cleft. The CRS program described above will cover all dental and orthodontic treatment relating to the cleft lip/palate. In Arizona, many if not most of the private health insurance plans do not cover dental work, even when it relates to the medical condition of cleft lip/palate. Because dental and orthodontic work are vital to the completion of cleft care, it is highly recommended that patients with commercial/private health insurance plans purchase dental insurance that includes an orthodontic benefit. Often the orthodontic benefit will only pay for a portion of the cost, but without that benefit the full financial responsibility for orthodontic treatment often falls on the family.

Insurance Advocates/Resources

There are resources to help you maneuver through insurance processes and problems. Here are a few to help:

  • CleftAdvocate
    This site has a list of resources to help, from discussions on how to communicate with insurance companies (what words/phrases to use and what words/phrases to avoid), to professional associations’ position on the care of cleft lip/palate
  • AmeriFace
  • Arizona Insurance Commissioner