Diagnosis: Malocclusion.
Treatment: D8080 Braces, D8670 Monthly Visit.

The insurer denied: D8080 Braces, D8670 Monthly Visit.
The denial is overturned.

The patient is a teenage male with skeletal class I occlusion. He has Class II canine malocclusion with moderate upper spacing and moderate lower crowding. He has a deep impinging overbite with soft tissue damage to palate. The request is for braces and monthly visits. The health plan's prior denial of coverage of the request was due to the patient's handicapping index score of 18. The denial is being appealed.

The requested braces and visits are medically necessary.

The patient has a deep, impinging overbite with soft tissue damage to his palatal tissue. This is an automatic qualifier according to the handicapping index scale. Orthodontic treatment is needed to correct this problem. Therefore, the request is medically necessary.