State of California—Health and Human Services Agency
Department of Health Care Services
SANDRA SHEWRY ARNOLD SCHWARZENEGGER
Director Governor
IF YOU WERE ELIGIBLE FOR MEDI-CAL ANYTIME SINCE JUNE 27, 1997, OR ARE ELIGIBLE NOW,
MEDI-CAL MAY REIMBURSE YOU FOR MEDICAL OR DENTAL BILLS YOU PAID
Conlan v. Bontá; Conlan v. Shewry
As the result of two court decisions, you may be able to be repaid for some medical expenses you paid.
The Department of
Health Care Services (DHCS) will assist you in getting your money back if all criteria below are met:
1. You received a medically necessary medical or dental service during one or all of these time periods:
9 The 3-month period prior to the month you applied for the Medi-Cal program,
9 From the date you applied for the Medi-Cal program until the date your Medi-Cal card was issued,
9 After your Medi-Cal card was issued (includes excess co-payment and excess share of cost charges).
2. You paid for your medical or dental service; or another person paid for your medical or dental service on your behalf. You
will be asked to provide proof that the medical or dental service was paid for by you or the other person.
3. You received the medical or dental service from a Medi-Cal enrolled provider (note: you do not need to have received the
service from a Medi-Cal enrolled provider if you received the medical or dental service during the 3-month period prior to
applying to Medi-Cal, or you received the services on or after June 27, 1997 but before February 2, 2006 and you had
applied for Medi-Cal but not yet received a Medi-Cal card).
4. For those Medi-Cal services that were provided and would have required Medi-Cal authorization, you have documentation
from the medical or dental provider that shows medical necessity for the service.
5. You were Medi-Cal eligible to receive that specific medical or dental service.
6. The medical or dental service was a benefit under the Medi-Cal program.
7. The medical or dental service was provided on or after June 27, 1997.
8. After you received your Medi-Cal card, you contacted your provider and showed your provider your Medi-Cal card and the
provider would not give you your money back.
Important dates and time frames:
• For services received June 27, 1997, through November 16, 2006, you must submit your claim by November 16, 2007, or
within 90 days after issuance of the Medi-Cal card, which ever is longer.
• For services received on or after November 16, 2006, you must submit your claim within one year of receipt of services,
or within 90 days after issuance of the Medi-Cal card, which ever is longer.
For more information or to file a claim, you MUST call or write to Medi-Cal at:
For Medical, Mental Health, Drug and Alcohol, and
In-Home Support Services Claims:
Department of Health Care Services
Beneficiary Services
P.O. Box 138008
Sacramento, CA 95813-8008
(916) 403-2007 TDD: (916) 635-6491
For Dental Claims:
Denti-Cal
Beneficiary Services
P.O. Box 526026
Sacramento, CA 95852-6026
(916) 403-2007 TDD: (916) 635-6491
--DON’T FORGET TO KEEP ALL RECEIPTS FOR THE MEDICAL AND DENTAL CARE YOU RECEIVE --
Medi-Cal will review your claim for repayment and send you a letter with a check or a denial letter that tells you the reason for
denial. If Medi-Cal denies your request for payment, you may ask for a state hearing. The denial letter will tell you how to ask
for a state hearing.
Medicare/Medi-Cal Coverage: Starting January 1, 2006, medications covered under Medicare Part D will not be a covered
benefit under the Medi-Cal Program and are not eligible for reimbursement. For questions regarding Medicare Part D contact
1-800-Medicare.
MC 210 A (09/07) Page 2 of
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