Common use of Medically Necessary Orthodontics Clause in Contracts

Medically Necessary Orthodontics. Orthodontic services will only be covered under this Section if the Member fits the following criteria: Members must have a fully erupted set of permanent teeth to be eligible for comprehensive orthodontic services. All orthodontic services require Authorization, a written plan of care, and must be rendered by a Provider. Orthodontic treatment must be considered medically necessary and be the only method considered capable of: Preventing irreversible damage to the member’s teeth or their supporting structures. Restoring the member’s oral structure to health and function.