A CLOSER LOOK AT COMMONALITY AND DIFFERENCES BETWEEN SECTION SCORES ON THE SALZMANN EVALUATION INDEX AMONG MEDICAID PATIENTS SEEKING ORTHODONTIC TREATMENT IN PENNSYLVANIA

Abstract

Objectives: The Salzmann Evaluation Index (SEI) is the malocclusion index used by Medicaid insurance administrators in Pennsylvania. An SEI of 25 is regarded as the threshold for approval. The SEI is broken into three subsections: intra-arch deviations (IAD; discrepancies within an arch), anterior Inter-arch deviations (AIAD; incisor antagonist relationships) and posterior inter-arch deviations (PIAD; posterior antagonist). This study identified discrepancies amongst the overall SEI score and subsection scores, in approved or denied cases with a SEI>25. Differences in subsection scores may identify malocclusion characteristics, other than overall scores, which drive insurance approval. Methods: The study sample included 570 subjects (295 approved and 275 denied). All subjects had a SEI>25. These scores along with a cephalogram, panorex, and intra/extra oral photographs, were previously sent to the administrator and a funding decision was rendered. SEI and subsection scores were compared between approved or denied treatment funding by T-Tests. Results: There was a significant difference in the overall SEI score between approved and denied records (p<0.001), with higher scores more likely to obtain approval. No difference was found for the IAD (p=0.195). Significant difference between approved and denied scores were found for both AIAD and PIAD (p<0.001). Effective subsection weight of contribution to the overall SEI was: IAD=55.38%, AIAD=24.86%, and PIAD=19.76%. Conclusions: Only 51.75% of subjects that had an SEI> 25 were awarded treatment funding. Although IAD contributes over half the total SEI, differences in this portion did not effectively influence insurance administrator decisions. There may be an inherent approval bias favoring malocclusions with crossbite, open bite, overbite, overjet, and sagittal tooth positions, rather than tooth-in-arch positions or overall SEI score.