It is normal practice for the California Victim Compensation Board (CalVCB) to pay for an initial examination and associated x-rays in order for a dentist to formulate a treatment plan for our victims.
CalVCB may pay for treatment of injuries caused by a crime, including but not limited to:
- Repair or replacement of broken or damaged teeth and dentures
- Temporomandibular (TMJ) disorders
- Diagnostic x-rays
- Cleaning (if necessary to provide crime-related dental procedures)
The following treatment is not generally allowed and the dentist should submit a preauthorization or pre-treatment estimate for consideration of treatment (see below):
- Periodontal Treatment: Periodontal treatment can only be considered in the area of the mouth that is affected by the crime related trauma since periodontal maintenance is a long-term, pre-existing problem not caused by trauma.
- Dental Implants: The need for an implant must be medically necessary and as a result of the crime. They are only allowed in unique situations and CalVCB will first consider less expensive conventional methods of restoration, e.g., bridge or partial denture.
- Cosmetic Dentistry to include Onlays, Laminate Veneers, temporary crowns and porcelain margins.
A CMS form is not needed. Most dentists submit bills on an ADA Dental Claim Form
- Patient's name and address
- Date(s) of service
- Type(s) of service(s) provided (diagnosis and procedure)
- CDT (Current Dental Terminology) code(s)
- Tooth number (if applicable)
- Charges for each procedure
- Total charges
- Provider's name, license number, federal tax identification number (FEIN or SSN), business address, telephone number, signature or signature stamp, and billing date
CalVCB pays 75 percent of the amount billed (subject to review of usual and customary rates).
Preauthorized Approval for Treatment
Dentists may be able to obtain preauthorized approval for treatment. Dentists must submit a pre-treatment estimate on an approved American Dental Association (ADA) Claim Form to the Board for review. This form can be faxed to (916) 491-6431. The Board will review the estimate to determine if the treatment is medically necessary and crime-related. The Board may request additional information, such as dental records, from the dentist prior to preauthorization of the estimated payment. Subject to available resources, dental estimates are reviewed as a courtesy to dentists and claimants to give them advanced notice as to whether the requested dental procedures may be reimbursed by CalVCB.
A claimant does not have the right to appeal the denial of a pre-treatment estimate because a pecuniary loss has not been suffered. However, the claimant may still undergo the dental treatment and then submit the incurred costs to the Program for reimbursement with the understanding that there is no assurance that the Program will reimburse these costs.
The Board will only issue a payment for preauthorized treatment after the services have been provided. Please contact our dental contact person at DentalContact@victims.ca.gov or our Customer Service Section at (800) 777-9229 for more information.