Dx: Dental Problems
Tx: Dental/Orthodontic Procedure:
Denied: Braces/monthly visits
Denial: UPHELD in whole

The patient in question is a male. He has a Class II malocclusion with minor maxillary and moderate mandibular crowding. He has been treatment planned for orthodontics to treat his crowding which was denied by the health plan as not medically necessary. The subject under review is the medical necessity of the treatment with braces and monthly visits.

The health plan's determination is upheld in whole.

The requested treatment of braces and monthly visits is not medically necessary. The patient does have a slightly deep bite, however, that alone is not a medical necessity to treat. The photographs do not illustrate any damage to the teeth or soft tissue damage from their current position. There are many ways to correct patients with a deep bite, and there is no strong evidence that one treatment is better than another. Furthermore, deep bites may be corrected in adulthood, so the patient would not lose the ability to correct the malocclusion should he choose to do so later in adulthood.