Diagnosis: Dental Problems
Treatment: Dental /Orthodontic Procedure
The insurer denied: braces
The denial is: Overturned in whole

The patient is a male with #9 in anterior crossbite. The patient was treatment planned for 24-30 months comprehensive orthodontics, but the plan was denied due to lack of medical necessity.

The health plan's determination is overturned in whole.

Braces are medically necessary for this patient. Treatment for the patient's anterior crossbite in the mixed dentition is medically necessary. It is a generally accepted practice guideline in orthodontics to treat anterior crossbites as soon as feasible because of the damage that can occur to the patient's dentition if left untreated. Side effects of an untreated anterior crossbite include abnormal wear to the affected teeth and labial displacement of the mandibular incisors that can lead to periodontal defects.1,2,3 These problems are much more time consuming and difficult to correct than the patient's existing orthodontic problem.