Diagnosis: Missing Tooth/Teeth
Treatment: Surgical placement of implant body: endosteal implant
The insurer denied Surgical placement of implant body: endosteal implant.
The health plan's determination is overturned.

This patient is a female being treated with chemotherapy for breast cancer, who had implants placed in the number (#)12 and #13 areas to replace a failed bridge. No sign of infection was noted.
At issue is the medical necessity of Surgical placement of implant body: endosteal implant.

The health plan's determination of medical necessity is overturned in whole.

The requested health service/treatment of Surgical placement of implant body: endosteal implant is medically necessary for this patient.
The options to restore function in this case are a removable denture or implants. Implants are the best choice. A partial denture has been shown to lead to the loss of adjacent teeth and have less chewing efficiency than implants. Implants are the standard of care and more efficient than a partial. Implants are the closest thing to natural teeth, preserve the bone and are not susceptible to caries. Implants are the generally accepted standard of care.
Therefore, the requested health service/treatment of Surgical placement of implant body: endosteal implant, is medically necessary.