Judge Barker overturned denial of Bridget Sharpe’s request for full upper and lower dentures, saying her Mercy Care Plan should have covered the teeth.
Because Mercy Care required evidence for medical need beyond the inability to chew, Sharpe told the administrative law judge that she needed “roughage” in her diet to help her lose enough weight to deal with her fibromyalgia.
Mercy Care’s dental director, Dr. Robert Thielen, rebutted her evidence by claiming she could sustain herself on a liquid diet.
The superior court affirmed the director’s decision.
Barker said the Arizona Health Care Cost Containment System misinterpreted the language of Sharpe’s medical policy “to preclude AHCCS enrollees from receiving the service (dentures) for the very purpose the Legislature granted it (so that enrollees can chew food).”
The court reversed and remanded, instructing the lower court to invalidate any denture requirements that demand more than the enrollee’s inability to chew.
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