Dental Problems
Dental/Orthodontic Procedure

Diagnosis: anterior crossbite
Treatment: Braces
The insurer denied braces. The health plan's determination is overturned.

The patient in question is a female with an anterior crossbite on tooth 10. She presents with a skeletal Class I malocclusion with moderate crowding in the maxilla and mandible. She is treatment planned for 24-30 months of orthodontics to address the crowding and crossbite, but the treatment was denied due to a lack of medical necessity.

Braces are medically necessary for this patient.
This patient presents with an anterior crossbite on tooth 10, as well as significant crowding. 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.
If left untreated the damage that will likely occur to the patients teeth will be much more time consuming and difficult to correct than the patient's existing orthodontic problem. For this reason, the treatment is deemed medically necessary.