Appeal Letter from OD ...

I thought I would post the appeal letter from my OD, first as an example for those who are seeking an appeal with their insurance company, and second, because it discusses in detail the issues I have with my jaw ...

To Whom It May Concern:

Stephanie is a very pleasant thirty-three years old female who initially visited our office for an orthodontic evaluation in July of 2001. Please let this letter serve as an appeal to denial of insurance coverage for the recommended surgery.

Clinically, Stephanie currently presents with a Class II division I subdivision left malocclusion in the permanent dentition stage. She has an overbite of eighty percent with six millimeters overjet. An increased mandibular curve of Spee exists. There are arch length deficiencies of five millimeters in the maxillary arch, and seven millimeters in the mandibular arch. Her maxillary and mandibualar arches are both asymmetric and tapered in arch form. In addition, her maxillary lateral incisors (7,10) are narrow in width.

Cephalometric measurements indicate a Class I skeletal relationship with ANB=9. Stephanie possesses a high mandibular plane angle that is indicative of an openbite skeletal pattern.

With the exception of the previous removed third molars (1,16,17, and 32) evaluation of Stephanie’s panoral film indicates all remaining permanent teeth present and accounted for with normal root form and structure and proper alveolar bone support.

Soft tissue profile evaluation indicates a slightly retrognathic profile with a recessive chin. Her upper and lower lips are both incompetent in their positions at repose with a seven-millimeter interlabial gap present. Her nasolabial angle is within normal limits at 130 degrees.

Evaluation of Stephanie’s upper smile line indicates a slightly high upper lip position with excessive gingival tissue displayed when smiling (four millimeters excess gingival tissue displayed when smiling). Evaluation of her lower smile line indicates an acceptable position of the lower lip with the maxillary dentition approximating the border of the lower lip. However, buccal corridors are evident upon smiling due to her asymmetric and tapered arch forms.

In addition to the above, Stephanie has had ongoing temporomandibular joint dysfunction concerns. Therefore, when Stephanie initially visited our office we recommended conservative measures for her TMJ discomfort which included: Aleve (2 tablets twice daily with food) or Ibuprofen (3 tablets three times daily with food), Glucosamine (as directed on package), moist heat applications (20 minutes two times daily), Soft diet (no gum, or sticky, chewy, crunchy foods), increased vitamin C (1,000 mg per day), journaling for one week, post-it notes and an increased awareness of her habits. When these conservative measures did not afford Stephanie relief, we fabricated a centric relation splint. Utilization of this appliance also did not prove to be successful in gaining Stephanie long-lasting relief from her TMJ symptoms. In addition, lower incisal wear has occurred. Stephanie relates that the right pre-auricular region of her TMJ’s has chronic discomfort. She also has migraine headaches, the right condyle is arthritic (indicated on the tomos we obtained), and her mandible deviates three millimeters to the right upon opening.

I have recommended treatment for Stephanie with full fixed orthodontic appliances in conjunction with a two-jaw surgical procedure with a maxillary advancement and impaction and mandibular advancement with chin augmentation. Stephanie does understand that while this comprehensive orthodontic/surgical treatment cannot guarantee a cure for her temporomandibular joint dysfunction, correcting her malocclusion may leave to improved symptoms.

Stephanie is aware that stellar elastic wear will be mandatory in order to reach her orthodontic goals. In order to address arch length deficiency, interproximal reduction in the mandibular arch will be necessary at the onset of her treatment.

The estimated length of treatment for Stephanie should be approximately twenty-four months. Upper pressdown and bonded mandibular lingual retainers will be utilized for retention. In addition, we may need to fabricate a centric-relation splint for retention, dependent upon the TMJ response to comprehensive orthodontic/surgical care.

Thank you very much again for consideration of insurance coverage for Stephanie’s surgery. In the absence of sugery Stephanie’s malocclusion puts her at increased risk for continued TMJ dysfunction and the potentioal for breakdown of her posterior detition (lower incisal wear is already noted). Should you have any questions or concerns in regards to my recommendations for Stephanie, or if we can provide additional diagnostics aside from those we have already submitted, etc., please do not hesitate to give me a call. I would be most happy to discuss the need for Stephanie’s surgery in conjunction with her comprehensive orthodontic care with you in person.