Dr. Gorin will provide orthodontic treatment for your child at no cost* to you if the case meets all of the following criteria:
The patient is covered under Medicaid orthodontic benefits
Dr. Gorin has examined the patient and has determined that the case fits within the guidelines of the NYS Medicaid orthodontic rehabilitation program. Additionally, Dr. Gorin took a complete set of orthodontic records, formulated a narrative, and submitted the record set and narrative to the MCO requesting comprehensive orthodontic treatment.
The patient has at least 1 of the 6 automatic qualifying HLD reporting indices.
The patient has been denied comprehensive orthodontic care by the MCO.
The patient received an adverse determination after a formal internal appeal to the MCO was considered.
The patient’s representative was present at a fair hearing and an administrative judge ruled in favor of the plan’s decision to deny care.
Dr. Gorin has had an opportunity to review the judge's decision, has discussed the denials with the patient’s representative and believes that the case remains within the guidelines of approvability.
*Dr. Gorin’s services include orthodontics only. Dr. Gorin will not incur the cost of extractions, surgical exposures of impacted teeth, jaw surgery, operative dentistry, restorative dentistry, rehabilitation dentistry, replacement of missing teeth, endodontic or periodontal services.