Diagnosis: Deep impinging overbite Treatment: D8080 Comprehensive Orthodontic Treatment of the Adolescent Dentition, Pre-service The insurer denied the D8080 Comprehensive Orthodontic Treatment of the Adolescent Dentition, Pre-service The denial is overturned. The patient is a male. The request is for dental benefits for orthodontic treatment (braces). Orthodontic records were created including x-rays and photos. The patient's clinical exam reveals mild spacing, slight protrusion of upper teeth, deep impinging overbite with tissue damage. The Health plan denied the treatment because the patient did not score a 26 on the Handicapping Labio-Lingual Deviation (HLD) Index. The provider appealed because the patient presents with a deep impinging overbite with tissue damage- - an automatic qualifier for orthodontic therapy on the Handicapping Labio-Lingual Deviation (HLD) index. Yes, the proposed treatment of orthodontic therapy (braces) is medically necessary. As evident on the photos, the patient has a deep impinging over-bite of almost 100 percent with damage to the gums on the upper anterior palate. The imprint of the lower incisors are visible within the folds of the rugae present on the upper palate; this shows the impact to the area. The extent of the over-bite is significant; if left untreated, it will continue to cause damage to the upper gum tissue as well as discomfort to the patient. This will adversely affect the patient's ability to have optimal chewing function as well as difficulty with speech. Long term, the patient may experience gum recession, strained facial muscles and ultimately jaw pain.

1) Evidenced Based Orthodontics -2nd ed by Greg J. Huang, Stephen Richmond, Katherine W.L. Vig (Wiley--2018). 2) Orthodontic Biomechanics: treatment of Complex Cases using clear Aligners by Tareh El-Bialy, Donna, Galante, Sam Daher ( Benthan Science-2016). 3) "Handicapping Labio-Lingual Deviation (HLD) Index Report ; effective 09/01/2012.