By skyforbes Location: Southern California
I have Medi-Cal and generally no issues with using it, but this is about a very specific situation.
I was denied dental treatment by Medi-Cal dental.
- My dentist wants to replace my 45-year-old root canals with crowns.
- Medi-Cal dental denied coverage.
- The dentist’s office said the reason given was: “not proven medically necessary.”
- But the paperwork I received only says: “deferred – not enough information.”
At this point, my only option is to request a Special Hearing with the State.
So…
- Has anyone been through this process?
- Google / AI doesn’t provide much about success rates.
- I can’t find anything about what percentage of applicants actually win these hearings.
- Are there clear metrics about what counts as “medically necessary”, or is it just up to the reviewer’s discretion?
- For context:
- The two teeth in question are extremely brittle.
- Since the root canals are 45 years old, I can really only chew with my molars.
- I’m not sure I can get strong documentation from my dentist, but I can ask him.
- Any ideas what exactly I should request that he provide?
- Has anyone here done this hearing?
- Did you go through it alone?
- Or did you hire someone to represent/counsel you?
Basically, I’m worried I’ll be asked questions by medical professionals and won’t know how to answer properly since I’m obviously not a medical professional myself.