Diagnosis: Malocclusion, overjet
Treatment: Braces and monthly visits
The health plan denied braces and monthly visits.
The health plan's denial is overturned.

The patient is a female child. The request is for orthodontic benefits with monthly visits. The patient has a Class II skeletal malocclusion with moderate upper and lower crowding. She has a deep bite with a severely excessive overjet.

The health plan denied coverage of the request due to the patient having a handicapping index scale score of 18. The denial is being appealed.

The patient has an overjet in excess of 9 mm (millimeters) with incompetent lip closure. This is an automatic qualifier according to the handicapping index scale. Orthodontic treatment is needed to correct this problem, and the monthly visits are needed to do follow ups and make sure treatment is progressing properly.