For services or supplies that aren’t completely covered by your primary insurance, you will need a written denial of coverage from your primary insurance as well as a prescription or order from your doctor showing that the service, medication, or supplies are medically necessary.
Example: A child requires a medically necessary piece of durable medical equipment that is excluded by the primary insurer. The parents should request a written denial. Once the written denial is received, parents can approach a DME company contracted with Medi-Cal and present the doctor’s prescription, a copy of the written denial, and their benefits ID card (BIC).
To get Medi-Cal to pay for consumables like incontinence supplies for children over the age of 3, you’ll follow the same process: obtain a written denial from your primary insurer and a prescription from your physician.
For more information, see How to Use Medi-Cal as Secondary Insurance.
