NYS Blue Choice Option MMC Dental Implant Converage – Success Stories?

Hey all,

We live in NYS and have Blue Choice Option w/ Dental (Managed Medicaid.) I have seen a few documents that mention implants can be covered by this plan if it is deemed a medical necessity, which cannot be remedied by RCT or dentures alone.

My loved one is in recovery from an eating disorder, ARFID, and has sensory processing disorder. They have received 5 implants in the last 3 years, replacing poorly done root canals/crowns. They will likely need a couple more, and would like to have them covered. Their sensory issues make eating with missing tooth, RCT crown (that fall out, caused past trauma/phobia of eating) or dentures impossible, and only implants feel as close to real teeth to them when eating.

Given that nutrition and sensory issues are their diagnosis', I feel that taking this angle in a claim or appeal would give them a strong case for coverage. We would have their PCP, Oral Surgeon, Occ. Therapist all write letters in support.

My question is, to those of you who have managed to get implants covered under Medicaid, what did your claim/appeal package look like or consist of? Thanks!

submitted by /u/Pilot_Yak3
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