Our plan covers dental services and procedures. These services may include, but are not limited to, the following:
- Oral Exams
- Cleaning – 3 every year
- Fluoride Treatment
- Endodontics* – 1 per tooth per lifetime
- Dentures, Oral Surgery, Other Services*
Our plan partners with Liberty Dental to provide your dental benefits.
Benefits exclusions and limitations may apply. There may be exceptions if medically necessary. Please note that some services require clinical review for pre-authorization approval prior to treatment. Certain documentation must be submitted with these pre-authorization requests.
These services are clinically reviewed using the provided documentation to determine if they are indicated and appropriate based on industry standards, and that they meet all requirements specific to such service as outlined in Liberty’s Clinical Criteria and Guidelines.
Any treatment which, in the opinion of LIBERTY’s Dental Director, is not necessary or does not meet plan’s criteria will not be covered. If the required documentation is not provided, the service cannot be adequately reviewed and will therefore be denied. If the prior authorization is denied for any reason, the service will not be covered, and you will be responsible for all associated costs. Dental procedures for cosmetic or aesthetic reasons are not covered. Coverage is limited to the services listed in the Schedule of Benefits.
For a detailed list of coverage, you can visit the Liberty Dental website or call 1-855-552-8243, Monday to Friday, 8:00 a.m. to 8:00 p.m., local time. Services that are not covered by our plan, may be available through the Medi-Cal Dental Program.
You can also reference the Member Dental Benefit Guide for coverage.
To locate a network dentist, you may call Liberty Dental Member Services at 1-855-552-8243 or search the online dental provider directory. It is recommended that you work with your in-network dentist to check benefit coverage prior to obtaining dental services. If you choose to use a dentist outside of the network, the services you receive will not be covered by our plan.
We pay for certain dental services, including but not limited to, cleanings, fillings, and dentures. What we do not cover is available through the Medi-Cal Dental Program, described in the Member Handbook. For a full list of services covered by the Medi-Cal Dental Program, call 1-800-322-6384 (TTY 1-800-735-2922) or visit Smile, California. These resources can also help you locate a Medi-Cal dental provider and file a grievance or complaint.
The following chart provides a comparison of what L.A. Care Medicare Plus (HMO D-SNP) offers and what Medi-Cal Dental Program offers.
|L.A. Care Medicare Plus (HMO D-SNP) Dental Benefits||Medi-Cal Dental Program (Dental Fee-for-Service or Dental Managed Care)|
|Your L.A. Care Medicare Plus (HMO D-SNP) Dental Benefits include:||Your Medi-Cal Dental Benefits include but not limited to:|