Diagnosis: Class I malocclusion
Treatment: Braces
The insurer denied braces.
The health plan's determination is overturned.

The patient is a female presenting with a skeletal Class I malocclusion and minor crowding. She has an anterior open bite. She has treatment planned for 24 to 30 months of orthodontic treatment to address the crowding and anterior open bite, but the treatment was denied.

The health plan did not act with sound medical judgment and in the best interest of the patient.

The requested health service and treatment of braces is medically necessary for the patient. Patients with an anterior open bite are among the most difficult patients to treat. One side effect of an anterior open bite is a reduced maximum bite force with less muscle activity while chewing than patients without an anterior open bite. Orthognathic surgery or permanent tooth extractions are often the choice of treatment to treat patients with an anterior open bite. This is not something that will self-correct without orthodontic intervention.