Can I balance bill a Denti-Cal beneficiary for the portion of my bill that wasn't paid by Denti-Cal ?
No. State law (22 CCR 51002) prohibits billing or collecting from Medi-Cal beneficiaries for any services included in the Denti-Cal program scope of benefits. In addition, federal law (42 CFR 447.15) requires states to limit participation in the Medicaid program to providers who accept as payment in full the amounts paid by the program plus any deductible.
The Denti-Cal provider handbook states that "once a provider has checked a beneficiary's eligibility or has submitted a claim or TAR (Treatment Authorization Request) for services, then that provider has agreed to accept that patient as a Denti-Cal patient. … The provider also agrees not to charge the beneficiary for all or part of any treatment that has been deemed by Denti-Cal to be a covered benefit."
Dentist Problems In Billing Forms With Patients
Common questions & answers with patients insurance collections and dental benefits plans.