Can reimbursement be obtained for excluded optional benefits if providers send in proof that the service was medically necessary?
No. The optional benefit is no longer a benefit of the Medi-Cal program. The only exceptions fall under special conditions and guidelines outlined in the Optional Benefits Exclusion section of the provider manual. A medical justification document will not exempt the beneficiary from receiving a service that is no longer a Medi-Cal benefit. Please review FAQ #2 on this page for more information.
Related Questions
- If a procedure or service is excluded from the members plan benefits, can we obtain authorization if we are able to establish medical necessity?
- If a procedure or service is excluded from a members plan benefits, can we obtain authorization if we are able to establish medical necessity?
- Can reimbursement be obtained for excluded optional benefits if providers send in proof that the service was medically necessary?
