Some doctors go on missions to Third World countries to treat children deformed by birth defects, disease and injury.

        But a Tristate physician has launched a charity organization to help disfigured people who live here.

        The Facial Foundation — launched by Dr. Kevin Shumrick, director of facial plastic surgery program at the University of Cincinnati Medical Center and supported by several other area doctors — has formed to raise money and arrange for reconstructive surgery for those without health insurance coverage.

        “We're not talking about a 16-year-old girl who wants the bump on her nose removed. We're talking about people who have been disfigured by something that happened to them,” Dr. Shumrick said.

        The people who could benefit from this fledgling charity include children and adults scarred by domestic violence, car accidents, dog attacks and a variety of other medical conditions.

        So far the foundation has taken on “a handful” of cases, Dr. Shumrick said. He said he started the foundation because he is seeing more patients running into coverage complications than he has seen in years.

        “Fewer patients have insurance. And for those who do, they make you jump through more and more hoops,” Dr. Shumrick said.

        Disputes about covering reconstructive surgery are common, even when children are involved, according to the American Association of Plastic Surgeons.

        A 1998 association survey of more than 700 plastic and reconstructive surgeons reported that 53 percent had a case that year in which a child was denied coverage for repairing damage from birth deformities, injuries or illness.

        Many disputes stem from a wide gap between the medical community and insurance companies over how to define cosmetic surgery.

        The American Medical Association defines cosmetic surgery as reshaping normal body parts to improve their appearance. Reconstructive surgery describes restoring function and normal appearance to abnormal body parts.

        But insurers don't necessarily agree with these definitions.

        Health plans set their own policies about covering cosmetic versus reconstructive surgery. Their policies — and the strictness of enforcing those policies — vary widely.

        Many routinely pay for treatments that restore function, such as making sure both nostrils work after a serious nose injury. But as long as all the parts work, many insurers consider treatments to restore normal appearance to be purely cosmetic and therefore, not covered.

        At a local level, the Facial Foundation can help some of the people who fall through the cracks in the system. But long-term, Dr. Shumrick said disputes about covering reconstructive surgery need to be resolved at the state or national level.

        Since 1997, the AMA and a dozen other medical interest groups, have been urging states and the federal government to pass the “Treatment of Childrens' Deformities Act,” which would mandate coverage of what the AMA defines as reconstructive surgery.

        In Congress, the deformity act proposal has repeatedly failed to reach a vote. Another version of the bill is expected to be re-introduced this year.

        Meanwhile, 15 states have passed laws mandating some forms of reconstructive surgery, including Indiana, which requires insurers to pay for repairing cleft palates and other congenital defects.

        To donate to the Facial Foundation, or to seek help from it, write to: The Facial Foundation; P.O. Box 670528; Cincinnati OH 45267-0528

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