The patient in question is a teenage male with a Class I occlusion, no crossbites, moderate overbite and overjet, and mild maxillary and mandibular crowding. He is treatment planned for 36 months of comprehensive orthodontics to correct his malocclusion. The health plan denied the treatment as not medically necessary. The health plan's determination is upheld.

The patient has mild maxillary and mandibular crowding. According to Caucasian cephalometric norms, the patient has protrusive maxillary incisal angles. However, this patient is not Caucasian and it is more appropriate to use an analysis that takes the patient's ethnic heritage into account, as ethnic differences lead to different cephalometric norms. Both patients of African descent and Hispanic descent have cephalometric norms that include more protrusive incisors than Caucasian norms. It is not medically necessary to upright the patient's incisors to adhere to cephalometric norms that are not in line with the patient's ethnic heritage. Additionally, there is no evidence provided that the patient is currently wearing his mandibular incisors due to his bite. For these reasons, orthodontic treatment is not medically necessary.