 | With Insurance: $200-$2,000+ |
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 | Without Insurance: $5,000-$20,000+ |
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| Cleft lip and palate surgery is used to repair a common birth defect. In a combination cleft lip and palate, which occurs in 50 percent of all cases, the sides of the palate and the sides of the top lip do not fuse together in early fetal development. Just a cleft lip or just a cleft palate occur in 25 percent of cases. | | |
| Typical costs: | - Without health insurance, cleft lip and/or palate surgery typically costs $5,000 to $10,000 or more per surgery; if the child has both a cleft lip and a cleft palate, two surgeries typically are required for a total of $10,000 to $20,000. For example, on RealSelf.com, Seattle plastic facial surgeon William Portuese estimates the cost of cleft lip/palate surgery at $5,000 to $7,000 per surgery. At Kids With Clefts Utah, two parents detailed their pre-insurance costs for surgery; for one, the total was $8,127.94 and for the other, $11,350.
- With health insurance, cleft lip and/or palate surgery typically costs several hundred to several thousand dollars, depending on deductible, copays and coinsurance for surgery. For example, CleftAdvocate.com provides sample letters from a real family who paid more than their $2,000 yearly out-of-pocket maximum.
- Cleft lip and/or palate surgery is considered reconstructive surgery to correct a birth defect, so it typically is covered by health insurance. However, some parents have had issues receiving their benefits. CleftAdvocate.org offers a list of states where insurance coverage of cleft repair is mandated, as well as advice for parents whose insurance companies deny coverage.
What should be included: | - In cleft lip surgery, which can be done at three months of age, the surgeon, will make one incision on each side the cleft, then pull tissue down and close the opening. If nose correction is necessary, it can be done at the same time.
- In cleft palate surgery, which can be done at nine months to a year, the surgeon will make incisions in the roof of the mouth and use flap techniques to move muscle and tissue to repair the cleft.
- The American Society of Plastic Surgeons offers an overview of cleft lip and palate surgery. CleftCare.org offers a surgery timeline.
Additional costs: | - Before surgery, parents probably need special bottles to make feeding easier. Snugglewraps.com sells these for $27 each.
- About half of children who have had a cleft palate will require speech therapy at some point, according to CleftLine.org. According to Speechville.com, the cost of speech therapy can range from free if offered by a local school district or covered by insurance, to $100 an hour. Children with cleft palate also typically require annual hearing tests because they are more prone to infections and middle ear problems.
- Children who have had cleft palate surgery usually require braces for their teeth, starting about age 5 or 6. In some cases, children need a bone graft as well, done by an oral surgeon, so teeth will come in correctly. According to a report by the California Health Benefits Review Program, the average lifetime cost of cleft-related orthodontic care is about $10,250. Several states mandate coverage of cleft-related orthodontics.
- Depending on the specific case, some patients require additional surgeries beyond the one or two initial lip and/or palate repairs; it is not uncommon for a patient to require five or more surgeries during their lifetime. According to the Utah Department of Health, the average lifetime cost for all treatment and services for a patient with cleft palate is $101,000.
Discounts: | - Shriners Hospitals for Children provides free cleft lip and palate repair, based strictly on the child's need for services, not on parent income.
- Also, some states have special programs to help parents pay costs that are related to cleft lip and palate but not picked up by insurance. For example, Vermont has the Children with Special Health Needs program.
- Charities such as Easter Seals offer speech therapy and other services for children with disabilities.
Shopping for cleft lip and palate surgery: | - Cleft lip and palate surgery requires a plastic surgeon, an oral surgeon, an otolaryngologist (ear, nose and throat specialist), an orthodontist and others. The National Craniofacial Association offers a list of craniofacial medical centers that have cleft palate teams in place.
- The National Craniofacial Association provides a list of resources for parents dealing with cleft lip and/or palate.
- Risks of cleft lip and palate repair include: bleeding, infection, scarring, dissatisfaction with results, asymmetry, nerve and/or tissue damage, and anesthesia risks, including death.
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Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
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Article updated June 2010 |
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