2013 DENTAL. Member Service Guide and Provider Directory. in partnership with AllCare Health Plan

Transcription

1 2013 DENTAL Member Service Guide and Provider Directory in partnership with AllCare Health Plan

2 in partnership with AllCare Health Plan, Inc. THANK YOU FOR USING THE ODS COMMUNITY HEALTH DENTAL CARE NETWORK! We are pleased to be your dental care network. If you have any questions call us at , TTY ODS s regular business hours are 7:00 a.m. to 7:00 p.m., Monday through Friday. Visit us at Dental Emergency A dental emergency is when you need same-day dental care. Emergencies include: A severe toothache Dental pain keeping you awake, not relieved by over the counter medications Infection in gums or a tooth Severe swelling of the gums around a tooth A tooth that has been knocked out If you are having trouble breathing or swallowing, that is a medical emergency. You can go to the emergency room. You should follow the emergency guidelines of your health plan. For a dental emergency please call your primary care dentist. If you cannot reach your primary dentist or you do not have one call ODS. ODS will help you find emergency dental care. Our toll free number is available 24 hours a day, 7 days a week. If deaf or hearing impaired you can call TTY/Voice number Ina true emergency, you can go to any emergency center without our approval. Some dental services require our Dental Director s approval before they can be performed. ODS Member Services Deaf or Hearing Impaired TTY

3 These are called pre-authorizations. Emergency or urgent services will not require a preauthorization that will delay treatment. You have the right to use any emergency center in a true emergency. Do not call after hours unless you have a dental emergency. Routine or urgent dental care calls should be made during regular business hours. If you aren t sure if it is an emergency, go ahead and call. Emergency While Away For a dental emergency while you are away from home, find a dentist nearby and call ODS if you can. We will speak to the dental provider to let him/her know what services are covered. We will cover services to stabilize the emergency. Follow-up care is not an emergency. Call your primary care dentist or ODS for follow-up care if needed. Urgent Dental Care Urgent dental care is when you need dental care soon, but not immediate treatment. Examples of urgent dental care are: A toothache Swollen gums Lost filling For urgent dental care call your primary care dentist (PCD). If you cannot reach your PCD or you do not have a PCD call ODS. We will try to get you an appointment within a few days or a week, depending on your condition. Primary Care Dentist ODS is a managed care dental plan. This means each member of your family needs to have a primary care dentist (PCD) to manage dental care. In selecting a PCD you need to choose a provider in our network. Your PCD will take care of most of your dental care needs. Choosing a PCD When you are ready to make an appointment you may call us for names of PCDs open to new patients. Or use the PCD list to call providers in your area. Let the provider know you are covered by AllCare and use the ODS network, and want to make an appointment. A provider may not accept new ODS patients. So if the PCD you called is not accepting new patients, select another PCD on the list to call. If you have difficulty finding a PCD call ODS for help. Only members without live teeth may select a denturist as a PCD. All members with live teeth MUST select a primary care dentist as a PCD. 4 ODS Member Services Deaf or Hearing Impaired TTY

4 Changing your PCD It is important to get to know your PCD. Only go to a different PCD if you have to. ODS allows a member to change providers twice. If you want a third change you must have a very good reason and ask ODS for our approval. Keeping Appointments Your choices affect not only you, but others. The number one reason dental providers give for not wanting to see OHP members is missed or late cancelled appointments. Arrive at your appointment on time. Keep all of your appointments. If you must cancel an appointment please call at least the day before. If you need help with child care or getting to an appointment, contact your caseworker. You may be able to get help. If you miss too many appointments a provider can refuse to see you and your family. Or a provider might decide to no longer see any future ODS members. Specialty Care Your PCD may refer you to a specialist if you need one. If you go to a specialist without a referral, you may have to pay the bill. But never pay a medical or dental bill without calling AllCare. Keeping appointments is important with any dental provider, even more so with a specialty care provider. There are few specialty care providers available. A missed appointment can mean the specialty care provider will not be willing to see you for a future appointment. Phased Treatment Planning Under the OHP, non-emergency restorative treatment (fillings, crowns, dentures) in the Plus package is limited. Treatment must be dentally appropriate, have a good outcome, be cost effective and practical. Dental disease is almost always preventable. It can be prevented with twice a day brushing, flossing, a low-sugar diet, and regular dental check-ups. ODS promotes phased treatment planning. Phased treatment planning is an order of doing dental services to get the best outcome. Pain and infection is treated. Next a routine visit, cleaning, or gum care as needed is done. Non-emergency services to restore teeth are considered. Services in the PLUS Package If you are on the PLUS Plan basic dental care is covered. Many services have limits and not all treatment is covered. PLUS Benefit Package services include: Exams, cleanings and x-rays Basic Restorative care like a filling Extractions ODS Member Services Deaf or Hearing Impaired TTY

5 Complex Restorative care like a denture (requires a pre-approval) Please call CDC for more information about covered services and which ones require prior authorization. Your PCD will discuss your treatment plan with you at the time of your visit. Services in the STANDARD Package If you are on the STANDARD Plan, only acute (happening right now) emergency dental services are covered. See Dental Emergency earlier in this guide for examples and a definition. Standard Benefit Package services include: Visit to Diagnose Emergency X-ray of the painful area/tooth Treatment to relieve pain Extraction Examples of services not covered are: a routine exam, root canal, fillings, dentures, and cleanings. Some Standard members have been assigned to a PCD for emergency dental treatment. Call ODS if you are unsure where to go for a dental emergency. Selecting a dentist You must choose a dentist as your Primary Care Dentist (PCD) before you may receive services from ODS. Each person in the family must have a PCD. Each person in the family may have a different PCD. If you already have a PCD, look in this directory to see if he/she is listed. If your PCD is not in our directory, you must choose one who is. PRIMARY CARE DENTISTS (PCDs) This directory lists all Primary Care Dentists (PCDs) in your area who accept ODS. If your PCD is on this list, you may stay with him/her. PCDs with an X by their name are open to new patients. PCDs with an X by their name are closed to new patients or are by referral only. This directory is current as of Please contact Member Services before selecting a new PCD, as availability changes frequently. Call Member Services toll free at Providers are also listed on our website at com. 6 ODS Member Services Deaf or Hearing Impaired TTY

6 Ashland Cullen Brandt L DDS 574 Washington St Ashland Central Point East Medford DENTAL CLINIC 4940 Hamrick Rd Central Point Hollander Jesse D DMD 4940 Hamrick Rd Central Point Roa Calie DDS 4940 Hamrick Rd Central Point Starley Matthew DDS 4940 Hamrick Rd Central Point Varro Cynthia R DDS 4940 Hamrick Rd Central Point Grants Pass Bright Now DENTAL 1021 NE 6th St Grants Pass Castle Kenneth F DDS 1035 NE 6th St Ste B Grants Pass Coombs Caleb V DMD 1010 NE 7th St Ste A Grants Pass Dental Vision PC 934 NE 8th St Grants Pass Dentex PC 1201 NE 7th St Ste D Grants Pass Erickson Sten DMD 1035 NE 6th St Ste B Grants Pass Kannan Poongkodi DDS 1201 NE 7th St Ste A Grants Pass Lillian David DDS 1035 NE 6th St Ste B Grants Pass Marynak Deborah L DDS 1021 NE 6th St Grants Pass Mudrow Kevin R DDS 1035 NE 6th St Ste B Grants Pass Nelson Steve A DDS 1035 NE 6th St Ste B Grants Pass Prins Brian L DMD 1010 NE 7th St Ste A Grants Pass Sanford Ross E DDS 1010 A NE 7th St Grants Pass Shishkin Igor DDS 934 NE 8th St Grants Pass Siskiyou COMMUNITY HEALTH CENTER 1035 NE 6th St Ste B Grants Pass Stirewalt Charles E DDS 1021 NE 6th St Grants Pass Tudor Blair J III DMD 1010 NE 7th St Ste A Grants Pass Uso Madrid III DDS 1010 A NE 7th St Grants Pass White Brandon A DDS 1021 NE 6th St Grants Pass Zdun Terry F DDS 1201 NE 7th St Ste D Grants Pass SPECIALISTS are by referral only, some providers may be closed to new patients. ODS Member Services Deaf or Hearing Impaired TTY

7 Medford Barsalou Luke T DMD 1113 Progress Dr Medford Catt James C DMD 3546 Lone Pine Rd Medford Established PATIENTS ONLY Chunduri Rajesh DMD 11 Rossanley Dr Medford E Main St Medford Coombs Caleb V DMD 832 E Main St Ste 10 Medford East Medford DENTAL CLINIC 1113 Progress Dr Medford Fine Amy B DMD 1113 Progress Dr Medford Getsinger Philip DDS 1113 Progress Dr Medford Gillespie Stephen DDS 2692 N Pacific Hwy Medford Hallin Allison G DMD 826 E Main St Medford Town Centre Dr Ste B Medford Hampton Kip L DDS 2665 Siskiyou Blvd Medford Hollander Jesse D DMD 1113 Progress Dr Medford Kittelson Ian T DDS 1113 Progress Dr Medford McGowan Kenneth DMD 1113 Progress Dr Medford Prins Brian L DMD 832 E Main St Ste 10 Medford Scott Tyler DMD 1113 Progress Dr Medford Siskiyou DENTAL ASSOCIATES 2665 Siskiyou Blvd Medford Southern OREGON DENTURE AND DENTAL 832 E Main St Ste 10 Medford Spencer David A DDS 2692 N Pacific Hwy Medford Uso Madrid III DDS 832 E Main St Ste 10 Medford Varro Cynthia R DDS 1113 Progress Dr Medford White Brandon A DDS 11 Rossanley Dr Medford SPECIALISTS are by referral only, some providers may be closed to new patients. 8 ODS Member Services Deaf or Hearing Impaired TTY