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- Stop Fraud and Abuse
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Beneficiary Frequently Asked Questions (FAQs)
Adult Dental Services FAQs
- Elimination of Most Adult Dental Services Beneficiary FAQs This document covers some frequently asked questions regarding the elimination of most adult dental services.
- How do I locate a dentist?
For assistance on finding dentists who accept new patients for the Medi-Cal Dental Program, you may call toll-free (800) 322-6384, Monday through Friday, 8:00 a.m. to 5:00 p.m.
- Can I be charged for services?
Services that are included in the Medi-Cal Dental Program's scope of benefits are not chargeable to the Medi-Cal dental beneficiary. However, you are responsible for any Share of Cost amount. You are also responsible for the benefits available under the Medi-Cal Dental Program that duplicate those provided under any other contractual or legal entitlements you are receiving.
- What is the Share of Cost program?
If your income is more than the Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses. The amount that you pay is called your Share of Cost (SOC). When you pay or promise to pay that amount, your SOC amount is considered met. Once you have met your SOC, Medi-Cal will pay the rest of your covered medical and dental bills for that month.
For example, if your SOC is $50 and your medical bills for services covered by Medi-Cal for that month are $500, you must pay $50. You have then met your SOC and Medi-Cal will pay the remaining $450. You may satisfy your SOC amount through any medical provider such as your doctor, dentist, pharmacy, or optometrist.
- Can I get a copy of my x-rays and records from my dentist?
You may obtain a copy of your x-rays or records from your dentist; however, your dentist may charge you a reasonable fee for their reproduction.
- What is the best time to call the Medi-Cal Dental Program?
The best time to call the Medi-Cal Dental Program is between 8:00 a.m. and 10:00 a.m Monday - Friday.
- How do I check to see if I'm eligible for the Medi-Cal Dental Program?
To check on your eligibility for Medi-Cal benefits, please contact your County Social Services office, listed in your local telephone book.
- I have misplaced my Benefits Identification Card (BIC); how do I get a new one?
Please contact your local County Social Services office, listed in your local telephone book.
- I am currently enrolled in a prepaid health plan/managed care plan; how do I change plans?
Call MAXIMUS, the State's Health Care Options Contractor at toll-free (800) 430-4263.
- Can I change dentists in the middle of treatment?
If services were prior authorized to one dentist and you wish to change your dentists, it is necessary that you write a letter indicating your change and have your new dentist submit that letter to the Medi-Cal Dental Program with his/her Treatment Authorization (TAR) form. The Medi-Cal Dental Program will contact your previous dentist to verify if any of the prior authorized services have been performed and will issue a new Notice of Authorization (NOA) as applicable.
- What if I am denied services requested for prior authorization?
If you are denied services that your dentist has requested prior authorization for, please contact your dentist to determine if a re-evaluation of the request could be made. You may also file a request through the Department of Social Services for a Fair Hearing by calling toll-free (800) 952-5253. You may also write to:
The Department of Social ServicesTo expedite your request, please include the Document Control Number (DCN). The DCN references the denied services.
State Hearings Division
P.O. Box 944243 MS 19-37
Sacramento, CA 94244-2430