top of page
< Back

201911-123419

2020

HIP Health Plan of New York

HMO

Dental Problems

Dental/ Orthodontic Procedure

Medical necessity

Overturned

Case Summary

Diagnosis: Impacted teeth
Treatment: Braces
The braces are medically necessary.

The patient has an impacted upper right lateral incisor and canine. When there is an, "impacted permanent anterior tooth where extraction is not indicated," as is the case for both of these teeth, this is an "automatic qualifier," as per the handicapping index. The patient needs, and is justified to receive, orthodontic benefits in this case.

bottom of page