Diagnosis: Dental Disorder
Treatment: Braces and monthly visits x12
The insurer denied Braces and monthly visits x12.
The determination is overturned.

The patient has a buccal (reverse) crossbite on teeth 3-5. She presents with a skeletal Class I malocclusion with maxillary and mandibular spacing. She is treatment planned for orthodontics; the treatment was denied due to lack of medical necessity.
At issue is the medical necessity of braces and monthly visits times (x) 12.

The requested treatment is medically necessary. Because teeth 3, 4, and 5 are in buccal crossbite, they have no antagonists. As a result, it is extremely likely that these teeth will overerupt. Once this overeruption occurs, it is very difficult to treat. (1) Buccal crossbite (also known as scissor-bite in the literature) can also negatively affect mandibular growth and should be treated as early as possible to eliminate the potential growth disturbance. (2)
If left untreated the damage that will likely occur to the patient's teeth will be much more time consuming to correct than the patient's existing orthodontic problem.
For these reasons, the requested treatment is medically necessary.