Helping Ben File an Appeal to Medicaid

Meet Ben, an older, disabled adult who needed dentures. Ben initially contacted PSLS from the emergency room. Ben had his teeth removed and Medicaid had approved Ben’s dentures, but Medicaid had denied the necessary pre-denture procedure Ben’s doctors required before his dentures could be fitted. The bones in Ben’s mouth needed to be modified in a pre-denture procedure for the dentures to fit properly. When Ben contacted PSLS, he was losing hope. Without teeth, daily life was challenging for Ben. Living without teeth made eating and proper nourishment very challenging. Ben reached out to PSLS for help appealing the Medicaid denial of coverage for the necessary pre-denture procedure. PSLS represented Ben at an administrative hearing and won. As a result of PSLS’ advocacy, the hearing officer determined that Ben’s pre-denture procedure was medically necessary, reversing Medicaid’s denial of coverage for the pre-denture procedure. Thanks to PSLS’ high-quality legal services, Ben’s Medicaid insurance approved coverage of both the pre-denture procedure and the dentures!