Diagnosis: Skeletal Class II Malocclusion, Retruded Mandible, Maxillary and Mandibular Crowding and Incisor Protrusion, Traumatic Bite and Excessive Overjet.

Treatment: Orthodontic Treatment of the Adolescent Dentition.

The insurer denied the Orthodontic Treatment of the Adolescent Dentition.
The denial was reversed.


This is an adolescent female per Orthodontic Treatment Program from late 2018 had skeletal class ll-retruded mandible, normal vertical growth pattern, permanent dentition, mild maxillary crowding, mild mandibular crowding, traumatic deep bite, moderate maxillary incisor protrusion, moderate mandibular incisor protrusion, and severely excessive overjet. Overjet greater than 9mm with incompetent lips or reverse overjet greater than 3.5 mm with reported masticatory/speech difficulties was indicated on the Handicapping Labio-Lingual Deviation (HLD) Index Report. The orthodontist has completed the Handicapping Labio-Lingual Deviation (HLD) index as required and has chosen the automatically qualifying condition of overjet greater than 9 mm with incompetent lips¿.to support orthodontic necessity. It is evident that the patient exhibits a significant malocclusion.

For this patient, the treating orthodontist claims an automatic qualifying condition of overjet greater than 9mm with incompetent lips or reverse overjet greater than 3.5 mm with reported masticatory/speech difficulties. This reviewer finds that this automatically qualifying condition criterion is met and does support comprehensive orthodontic care. The clinical circumstance does meet insurer and plan criteria to justify orthodontic care. Regarding the validity of the Handicapping Labiolingual Index, it has been shown through scientific scrutiny in peer reviewed journals that this methodology for assessing orthodontic need is a valid approach.

Based on the above, the medical necessity for the Comprehensive Orthodontic Treatment of the Adolescent Dentition is substantiated. The insurer's denial is reversed.