Primer on state statutory mandates of third-party orthodontic coverage for cleft palate and craniofacial care in the United States

Kristin D. Pfeifauf, Alison Synder-Warwick, Gary B. Skolnick, Sybill D. Naidoo, Richard J. Nissen, Kamlesh B. Patel

Research output: Contribution to journalArticle

4 Scopus citations

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.

Original languageEnglish
Pages (from-to)466-469
Number of pages4
JournalCleft Palate-Craniofacial Journal
Volume55
Issue number3
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Keywords

  • Cleft lip
  • Cleft palate
  • Craniofacial
  • Insurance
  • Orthodontics
  • Third-party coverage

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