The American Association of Endodontists (AAE), in partnership with the Organized Dental Coalition (ODC) and more than 70 national health professional and patient advocacy organizations, recently urged Congress to advance the Ensuring Lasting Smiles Act (ELSA) (S. 1677/H.R. 3277). Through a coalition letter sent to leaders of the Senate Committee on Health, Education, Labor, and Pensions and the House Committee on Energy and Commerce, the organizations called on Congress to schedule committee markups and move this bipartisan legislation forward before the end of the 119th Congress. 

The Ensuring Lasting Smiles Act addresses a longstanding gap in private health insurance coverage for children born with congenital anomalies affecting the eyes, ears, teeth, mouth, or jaw. Although many health plans indicate they cover congenital anomalies, families frequently encounter coverage denials when follow-up or reconstructive care is needed. Medically necessary services—including dental implants, prosthodontic treatment, orthodontics, and other restorative procedures—are often classified as cosmetic or shifted to supplemental dental or vision plans, leaving families responsible for significant out-of-pocket costs. 

For children with craniofacial conditions such as cleft lip and palate, ectodermal dysplasia, hypodontia, and other congenital anomalies, access to timely multidisciplinary care is critical. Treatment often spans several years and involves coordination among medical and dental specialists to restore normal function as a child grows and develops. Delays in care can affect speech, nutrition, breathing, oral function, and overall quality of life while creating unnecessary financial and emotional burdens for families. 

ELSA would help ensure that private group and individual health plans provide coverage for medically necessary services needed to improve, repair, or restore normal function for patients with qualifying congenital anomalies. The legislation is carefully tailored to address functional reconstructive care and does not require coverage for procedures performed solely for cosmetic purposes. Previous Congressional Budget Office analyses have estimated that the legislation would have a minimal impact on insurance premiums while helping families avoid costly delays in treatment. 

The legislation continues to receive strong bipartisan support in both chambers of Congress and is championed by Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA), along with Representatives Neal Dunn, D.M.D. (R-FL) and Kim Schrier, M.D. (D-WA). The broad coalition supporting ELSA reflects a shared commitment among healthcare providers and patient advocacy organizations to ensure children with congenital anomalies have access to medically necessary care without unnecessary insurance barriers. 

The AAE is proud to stand alongside the Organized Dental Coalition and its healthcare partners in advocating for policies that improve patient access to essential oral healthcare. As part of its broader advocacy efforts, the Association will continue working with Congress, coalition partners, and policymakers to advance practical solutions that remove barriers to care, strengthen insurance coverage for medically necessary treatment, and improve outcomes for patients and their families. 

The American Association of Endodontists (AAE), in collaboration with the American Dental Association (ADA), the Organized Dental Coalition (ODC), and other national dental organizations, recently expressed its support for the Ensuring Kids Have Access to Medically Necessary Dental Care Act. In a coalition letter sent to Senator Angela Alsobrooks (D-MD) and Representative Nanette Barragán (D-CA), the organizations thanked the lawmakers for introducing the legislation and reaffirmed their commitment to advancing policies that improve children’s access to essential oral healthcare. 

The proposed legislation would strengthen dental coverage under the Children’s Health Insurance Program (CHIP) by prohibiting lifetime and annual dollar limits on dental benefits and requiring dental-only wraparound coverage for certain children whose existing health plans do not provide adequate dental benefits. These changes would help ensure that children enrolled in CHIP can receive medically necessary dental care without facing arbitrary financial limitations that may interrupt treatment or place additional financial burdens on families. 

Although CHIP has played a critical role in expanding access to healthcare for millions of children, gaps in dental coverage continue to create barriers for many families. Annual and lifetime benefit caps can leave children without coverage in the middle of treatment, forcing parents to delay care, pay significant out-of-pocket costs, or forgo treatment altogether. The coalition emphasized that oral health is a fundamental component of overall health and that children should have access to comprehensive dental care throughout their development. 

Routine preventive care and timely treatment help reduce the risk of dental disease, pain, infection, and costly emergency care while supporting healthy nutrition, speech development, learning, and overall well-being. Ensuring continuous access to dental services also helps providers deliver appropriate care without unnecessary interruptions caused by insurance limitations. Strengthening CHIP’s dental benefits would improve continuity of care while helping families better manage the financial challenges associated with ongoing treatment. 

By supporting this coalition effort, the AAE continues to advance its commitment to improving access to quality oral healthcare through federal advocacy. Working alongside the ADA, the Organized Dental Coalition (ODC), and other national dental organizations, the Association remains engaged in efforts to reduce barriers to medically necessary dental care, strengthen insurance coverage for patients, and promote policies that improve oral health outcomes for children and families across the country.

AAE Advocacy was on the ground at APICES, held August 14–15 in St. Louis, Missouri, connecting with endodontic residents and highlighting the important role advocacy plays in shaping the future of the specialty. 

Throughout the meeting, residents had the opportunity to connect directly with AAE Advocacy staff, learn more about the Association’s federal advocacy priorities, and take action in support of the Resident Education Deferred Interest (REDI) Act. AAE Advocacy staff engaged with approximately one-quarter of the residents in attendance, demonstrating strong interest among the next generation of endodontists in learning more about the issues affecting their profession and how they can make their voices heard. The bipartisan REDI Act would allow dental residents to defer federal student loan payments during residency without interest accruing during that period, helping reduce the financial burden many residents face while completing advanced specialty training. AAE has continued to support the REDI Act as part of its broader efforts to strengthen the dental workforce and support the next generation of endodontists. 

APICES also provided an important opportunity to introduce residents to grassroots advocacy early in their professional careers. Grassroots advocacy is a critical part of AAE’s overall advocacy strategy because lawmakers need to hear directly from the individuals who are affected by the policies they consider. While AAE staff can provide lawmakers with policy expertise and information, messages from practicing endodontists, residents, and other constituents help put a personal face on those issues and demonstrate their real-world impact. 

By participating in grassroots campaigns, AAE members can help educate elected officials about the challenges facing the specialty, reinforce the importance of policies that support patient access to high-quality endodontic care, and ensure that the voice of endodontists is represented in policy discussions. Even a simple message to a Member of Congress can help build awareness and strengthen the Association’s ability to advocate effectively on behalf of the specialty. 

Engaging residents at APICES is also an important investment in AAE’s long-term advocacy efforts. Residents represent the future of endodontics, and introducing them to advocacy now helps build a stronger, more informed network of members who are prepared to participate when important state and federal issues arise. AAE’s goal is to continue growing this nationwide grassroots network so that members can be mobilized quickly and effectively in support of legislation affecting endodontists and their patients. 

The enthusiasm and participation from residents in St. Louis reinforced an important message: advocacy is most effective when endodontists at every stage of their careers are informed, engaged, and willing to make their voices heard. 

As the second installment in the AAE’s quarterly series on coding and reimbursement, this article explores practical strategies for writing strong dental narratives to support claim submissions and reimbursement outcomes.

Navigating dental benefits is an important part of practice management. Submitting a clear dental narrative is a key component during the insurance submission to make sure that your claims are approved upon the first submission. Additionally, a dental narrative may be requested from an insurance carrier when an insurance claim involves major or extensive dental treatment.

Tips for Submitting a Strong Dental Narrative

1. Understand the dental benefit plans coverage inclusions and exclusions. Do not spend time and energy writing extensive narratives that will be denied based on the plan’s policy. Insurances are upfront about procedures that are not covered benefits. This information is readily available through the online portals. Alternatively, a verbal breakdown of the patient’s insurance benefits can be determined by speaking with the insurance carrier directly. Keep in mind these phone calls have long wait times. It may be wise to invest the time to train your administrative staff how to access each carrier’s online portals to be more productive.
2. Customize each narrative to accurately explain the procedure in question. Prewritten dental narrative templates often result in denials. Templates tend to provide vague details and do not expertly narrate the procedure. A narrative should explain the patient’s dental problem and the procedural solution with factual evidence. Although writing individual narratives for each claim is time consuming, taking the extra steps and time to do so will results in a higher acceptance rate.
3. Narratives should be succinct. You want to relay all relevant information to support your claim. Stick to the “who, what, where and why.” For example, a narrative for a non-surgical retreatment may include the following details:
   1. Date of initial root canal therapy
   2. The current condition of the tooth; restorative history, location of caries
   3. Pulp testing
   4. Description of a periapical lesion
   5. Endodontic and periodontic diagnosis
   6. Patient’s chief complaint or symptoms
   7. All radiographic imaging
4. Add context to support the treatment provided. Explain to the insurer that failure to provide the procedure performed may result in future complications. Support your procedural decision with evidence-based facts such as non-surgical retreatment success rates.
5. Always maintain professionalism. Proofread your narrative before submission. Do not abbreviate words or use catch phrases unfamiliar to a dental insurer. Attach all supporting documentation in the proper downloadable format to avoid further delays. This includes but is not limited to imaging and digital clinical notes.

Dental Narratives are not a guarantee that a claim will be approved and processed. However, a well prepared narrative remains an important part of the insurance submission process and can greatly speed up the reimbursement process.

Dental narratives are not a guarantee that a claim will be approved and processed. However, a well-prepared narrative remains an important part of the insurance submission process and can greatly speed up the reimbursement process.

Questions for Our Coding Experts?

The AAE Practice Affairs Code Maintenance Committee welcomes questions from AAE members related to CDT coding and reimbursement education. Members may contact advocacy@aae.org with coding-related questions.