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- Title
Primer on State Statutory Mandates of Third-Party Orthodontic Coverage for Cleft Palate and Craniofacial Care in the United States.
- Authors
Pfeifauf, Kristin D.; Synder-Warwick, Alison; Skolnick, Gary B.; Naidoo, Sybill D.; Nissen, Richard J.; Patel, Kamlesh B.
- Abstract
Provision and timing of orthodontic treatment is a crucial part of comprehensive cleft palate and craniofacial care. Some states statutorily mandate orthodontic coverage for the medically necessary care of cleft palate and craniofacial anomalies. However, application of the medically necessary standard varies broadly. Disputes over medical necessity lead to orthodontic coverage denials and surgical intervention delays. Provider-friendly statutory definitions of medical necessity enable patients and providers to avoid such hurdles. The objective of this study is to evaluate state mandates and highlight language favorable to patients and providers.
- Subjects
UNITED States; HEALTH insurance reimbursement laws; CLEFT palate; ORTHODONTICS; CRANIOFACIAL abnormalities; STATE health plans
- Publication
Cleft Palate Craniofacial Journal, 2018, Vol 55, Issue 3, p466
- ISSN
1055-6656
- Publication type
Article
- DOI
10.1177/1055665617736765