top of page
202005-128270
2020
Fidelis Care New York
Medicaid
Dental Problems
Dental/ Orthodontic Procedure
Medical necessity
Overturned
Case Summary
Diagnosis: Anterior crossbite
Treatment: Braces
The insurer denied the braces.
The denial is overturned.
The patient is a female. The request is for orthodontic benefits.
Yes, the proposed braces are medically necessary.
The patient has an anterior crossbite between teeth #'s 10 and 23, with gingival attachment loss. This is an "automatic qualifier" for orthodontic benefits according to the handicapping index scale.
bottom of page