CHARLOTTE, N.C. — A Charlotte area surgeon is changing the lives of his patients by fighting to help them when insurance companies won’t. Congress is working to help these families but until then this surgeon is seeking solutions on his own.
Children with cleft lip and palate need a lot of specialized care, much of which insurance doesn’t cover. So Dr. Rick Kapitain in Charlotte is helping assist families with medical costs.
Two-and-a-half-year-old Ford Plyler suffers from cleft lip and palate. His mother, Alexis, found out while she was just 18 weeks pregnant with Ford that he would have the issue.
"He was definitely gonna look different," Alexis remembers thinking. "They laid out the timeframe of the different surgeries he would have."
He’s already had three surgeries and there are more to come – but the surgeries are just the beginning of the problem.
"He doesn’t talk so we go to speech once a week," Alexis said. "He doesn’t eat much so we have to do weight checks."
The family pays for all the therapies out of pocket.
Kapitan is Ford’s doctor. He’s a cleft and craniofacial surgeon here in Charlotte – one of only a handful of surgeons in the state who specializes in caring for kids like Ford.
"We've seen families have to sell possessions, crowdsourcing for something you would think the insurance they pay into would provide," Kapitan said.
He says right now insurance companies don’t pay for a lot of the dental work and therapies these patients need.
"But the real story and the challenge for patients is all the nonsurgical care – once people get over the shock of how much surgery is involved, they’re just exposed to nonsurgical therapies that can extend beyond 18 into adulthood," Kapitan said.
That’s why Kapitan started the Face 2 Face Foundation, providing medical grants to patients and their families.
"In 2017 after many years of feeling frustrated that these parents were willing to follow recommendations of our team and to know we have the resources for them here in Charlotte to do that but then parents turn to the insurance company to achieve that care they get denied," Kapitan said.
There’s a bill before Congress called the Ensuring Lasting Smiles Act that could soon change that.
"[The bill] would forbid insurance companies coding these procedures as cosmetic or not medically necessary and provide coverage the way they would for any other birth anomaly that effects any other part of the body," Kapitan said. "To have it come down to a mathematical equation of what parents can afford to pay for is out of reach, it's heartbreaking and motivation to keep doing what we're doing until we're not needed anymore."
If you’d like to know more about the Face 2 Face Foundation, visit here.
