2014 DENTAL. Member Service Guide and Provider Directory. in partnership with AllCare Health Plan

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1 2014 DENTAL Member Service Guide and Provider Directory in partnership with AllCare Health Plan

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3 DENTAL Directory in partnership with AllCare Health Plan THANK YOU FOR CHOOSING LA CLINICA FOR YOUR DENTAL NEEDS. 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 La Clinica at La Clinica will help you find emergency dental care. If deaf or hearing impaired you can call TTY/Voice number In a 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. 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 are nott sure if it is an emergency, go ahead and call. La Clinica Dental Member Services Deaf or Hearing Impaired TTY

4 DENTAL Directory Emergency While Away For a dental emergency while you are away from home, find a dentist nearby and call La Clinica 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 La Clincia 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 La Clinica. We will try to get you an appointment within a few days or a week, depending on your condition. Primary Care Dentist La Clinica works with AllCare to manage your dental care. This means each member of your family needs to have a primary care dentist (PCD) at La Clinica or one of our other dental plans 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. Changing your PCD It is important to get to know your PCD (Primary care dentist). Only go to a different PCD if you have to in case of emergency or by a referral from La Clinica. 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. Specialty Care Your PCD at La Clincia 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 4 La Clinica Dental Member Services Deaf or Hearing Impaired TTY

5 DENTAL Directory 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) is limited. Treatment must be dentally appropriate, have a good outcome, and 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. La Clincia 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 Package Many services have limits and not all treatment is covered. Services include: Exams, cleanings and x-rays Basic Restorative care like a filling Extractions Complex Restorative care like a denture (requires a pre-approval) Please call La Clinica Dental for more information about covered services and which ones require prior authorization. Your PCD (primary care dentist) will discuss your treatment plan with you at the time of your visit. PRIMARY CARE DENTISTS (PCDs) This directory lists all Primary Care Dentists (PCDs) in your area who accept CDC. If your PCD is on this list, you may stay with him/her. PCDs with an 5 by their name are open to new patients. PCDs with an 5 by their name are closed to new patients or are by referral only. This directory is current as of February 4, 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 www. allcarehealthplan.com. La Clinica Dental Member Services Deaf or Hearing Impaired TTY

6 DENTAL Directory PRIMARY CARE DENTISTS (PCDs) This directory lists all Primary Care Dentists (PCDs) for La Clinca Dental. PCDs with an 5 by their name are open to new patients. PCDs with an 5 by their name are closed to new patients or are by referral only. This directory is current as of October 1, Please contact La Clinca Member Services for any changes to your primary care dentist at Providers are also listed on our website at PRIMARY CARE DENTISTS (PCDs) This directory lists all Primary Care Dentists (PCDs) in your area who accept La Clinica Dental. If your PCD is on this list, you may stay with him/her. Call Member Services toll-free at Providers are also listed on our website at Central Point CENTRAL POINT HEALTH CENTER 4940 Hamrick Rd Central Point Horario: Lunes a viernes, 7:30 a.m. a 6:30 p.m. Conklin, Anton DMD Diaz, Daniela DMD Medford EAST MEDFORD DENTAL CLINIC 1113 Progress Dr Medford Horario: Lunes a viernes, 7:30 a.m. a 6:30 p.m. Coe, Erica DMD Fine, Amy DMD Getsinger, Philip DMD Hollander, Jesse DMD Kittelson, Ian DMD McGowan, Kenneth DMD Stein, Andy DMD Scott, Tyler DMD Wilson, Tyler DMD 6 La Clinica Dental Member Services Deaf or Hearing Impaired TTY

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8 LaClinica DentalDIR October 22, 2014 Central Point Health Center 4940 Hamrick Road Central Point, Oregon East Medford Dental Clinic 1113 Progress Dr. Medford, Oregon Member Services If Deaf or Hearing Impaired TTY/VOICE Number GRANTS PASS 740 SE 7th Street Grants Pass, OR Tel Medford 1390 Biddle Road, Ste. 105 Medford, OR Tel Member Services Toll-Free TTY/ TDD