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202002-125353
2020
Healthfirst Inc.
Medicaid
Dental Problems
Dental/ Orthodontic Procedure
Medical necessity
Overturned
Case Summary
Diagnosis: Crossbite
Treatment: Braces
The insurer denied braces.
The denial is overturned.
The Braces are medically necessary.
The patient has a crossbite of an anterior tooth (#27, lower right canine) with attachment (gum) loss. This is an automatic qualifying condition according to the handicapping index scale. Orthodontic treatment is medically necessary to correct this problem.
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