Dental Member Handbook and Provider Directory

Transcription

1 Dental Member Handbook and Provider Directory Oregon Health Plan May (07/11)

2 WELCOME We are pleased you have selected ODS as your Oregon Health Plan (OHP) managed dental plan. ODS and its providers want to give you the best possible care. It is important that you know how to use your dental plan. This handbook tells you about our program and how to get dental care. We ll also give you tips on getting the most out of your dental plan. Here, you ll learn about the two dental plans available through the OHP Plus and Standard and how the Plus plan is different for members under 21 years old and pregnant women. To find out which plan you have, please contact ODS OHP Dental Customer Service. For a complete list of ODS participating dentists and denturists, see the provider directory at the end of this handbook. Your ODS OHP Dental Member Handbook is not complete without the Oregon Health Plan Client Handbook. The state of Oregon will send you the OHP Client Handbook on request. It gives you important information that may not be covered in the ODS handbook. To ask for a copy, call (TDD/). You can read it online at If you have questions about ODS, selecting a primary care dentist (PCD) or any other information in this handbook, please contact ODS OHP Dental Customer Service: In Portland: Toll-free: TDD/ (For hearing- and speech-impaired) The Customer Service office is located at SE 17th Ave., Milwaukie, OR Customer Service is open from 7:30 a.m. to 5:30 p.m. Pacific time, Monday through Friday. Physical access is available for members with disabilities. You may also visit our website at or us at OHPDental@odscompanies.com.

3 English This document can be provided in other formats, including large print. Call ODS at or TDD/TTY at 711 to request another format. Korean ODS, 711 TDD/TTY. Lao ເອກະສານນ ສາມາດຖ ກສະໜອງໃຫ ໃນ ຮ ບແບບອ ນ, ລວມທ ງແບບຕ ວພ ມ ໃຫຍ. ໂທຫາ ODS ທ ເບ ຫ ເບ ຜ ບ ກຜ ອງການໄດ ຍ ນ TDD/TTY ທ ເບ 711 ເພ ອຮ ອງຂ ເອ າຮ ບແບບອ ນໃດໜ ງ. Russian Этот документ может быть предоставлен в других форматах, в том числе и в печатном виде крупным шрифтом. Чтобы заказать этот документ в другом формате, позвоните ODS по телефону или телетайпу (TDD/TTY) 711. Somali Dokumeentigaan waxaad heli kartaa isagoo hab kale u qoran, oo ay ku jirto xarfaha waaweyn. Ka soo wac ODS ama TDD/TTY 711. Si aad u codsato hab kale. Spanish Este documento se puede proporcionar en otros formatos, incluso en letra grande. Llame a ODS al o TDD/TTY al 711 para solicitar otro formato. Vietnamese Tài liệu này có thể được cung cấp dưới các định dạng khác, bao gồm cả bản in cỡ lớn. Để yêu cầu bản định dạng khác, vui lòng gọi tới ODS theo số hoặc TDD/TTY theo số

4 TABLE OF CONTENTS New members... 5 Other forms of this handbook... 5 Getting started Choosing a primary care dentist (PCD)... 5 Changing your PCD... 6 DHS Medical Care ID card... 6 ODS Dental ID card... 6 Dental clinic assignments... 7 Getting care How to make a dental appointment... 7 If you cannot keep your appointment... 8 Interpreter services... 8 Referrals for specialty care... 8 Prior authorization... 8 After-hours dental care... 8 Urgent dental care... 9 Emergency dental care... 9 Emergency dental care when you are away from home... 9 OHP benefits and services Non-covered services... 9 OHP Plus benefit plan... 9 Preventive care Other covered services Prescription medications OHP Standard plan OHP Dental covered and non-covered services chart Tooth chart Member rights and responsibilities Complaints and appeals Complaints Appeals OHP administrative hearings Other important information Changes to your address or phone number

5 Confidentiality How to get copies of your dental records If you become pregnant Non-emergency transportation Help with quitting tobacco use Member disenrollment request Plan disenrollment request DMAP Oregon Health Plan Client Handbook Information available upon request: ODS Community Health, Inc Physician reimbursement The ODS provider directory This document can be provided in other formats, including large print. Call ODS at or TDD/TTY at 711 to request another format. 4

6 New members If you need dental care before you receive your ID card, your plan will pay for covered services. These services may include an exam, X-rays and other necessary items. Please call Customer Service at (TDD/) and we will help you find a dentist and get the care you need. Other forms of this handbook You can receive this handbook and other information in different forms, such as: Another language Large print Computer disc Audio tape Oral presentation Braille Please call Customer Service to request the format you need. You will not be penalized in any way for asking for this information. GETTING STARTED Choosing a primary care dentist (PCD) Your ODS OHP dental plan is a managed care plan. You need to choose a clinic or dental office as your primary care dentist (PCD). Your PCD will work with you to take care of your dental needs. Call your PCD before seeking dental care. See the provider directory or call Customer Service for your PCD s phone number. Your PCD will: Provide all of your routine and primary dental care Arrange for specialty care when needed Write prescriptions (only for dental needs) Keep your dental records Do not wait until you are in pain to call a PCD. Call your PCD s office and tell them you are an ODS member and have selected them as your PCD. Ask about office hours and how to get help after hours when you have an emergency. If you have not seen a dentist for more than six months, make an appointment when you first become an ODS member. After your first visit, you will be an established patient, or patient of record. Once you are an established patient, your PCD will provide emergency dental care 24 hours a day, seven days a week. 5

7 Changing your PCD You may change your PCD two times every year. To choose a new PCD, use the provider directory at the end of this handbook. Be sure to have each eligible member of your family choose a PCD. Each person can have a different provider. DHS Medical Care ID card The Department of Human Services (DHS) Division of Medical Assistance Programs (DMAP) will send you a Medical Care ID card when you first enroll in the OHP. Each OHP member in your household will receive his or her own card. Take your card with you to medical or dental appointments. If you lose your card, contact your DHS worker or Client Services at to get a new one. DHS also sends you a coverage letter that shows your case worker s ID and phone number, your benefit package and enrollment information. The letter shows information for everyone in your household who has a DHS Medical Care ID card. ODS Dental ID card We send each ODS member an ODS Dental ID card along with your Member Handbook. This card is important because it identifies you as an ODS member and has other information for you and your providers. It tells you what to do in an emergency and lists Customer Service phone numbers. Be sure to show your ODS Dental ID card and DHS Medical Care ID card each time you go to the dentist. If you lose your ODS Dental ID card, call Customer Service at to request another card. 6

8 Dental clinic assignments Members who live in Clatsop and Columbia counties: Contact one of these dental clinics for care. Your ODS Dental ID card and welcome letter also list your dental office and the contact information for making appointments. Tyack Dental Group Tyack Dental Group th St. 400 SW Belair Dr. Astoria, OR Clatskanie, OR OHP Standard plan members in Multnomah, Clackamas or Washington counties: If you are on the Standard plan (there is a B in box 9B on your DHS Medical Care ID card), please contact this dental clinic for emergency dental care. Your ODS Dental ID card and welcome letter also list your dental office and the contact information. OHSU Russell Street Dental Clinic Telephone: N Russell St. After hours: Portland, OR ODS assigns Standard OHP members in Washington, Multnomah and Clackamas counties to the Russell Street Clinic in Portland. But members may have a good reason for needing a different clinic. You may already have a different dentist, or traveling to the Russell Street Clinic may be difficult, or you may have some other reason for needing a different dentist. If so, call Customer Service at and ask ODS to assign you a different dentist. GETTING CARE How to make a dental appointment Call your PCD during office hours (normally 9 a.m. to 5 p.m.). If you need your PCD s number, check the provider directory or call Customer Service. Tell the office you are an ODS OHP member and why you need to see a dentist. If possible, give your PCD a phone number where you can be reached. Remember to take your DHS Medical Care ID card and ODS Dental ID card with you to your appointment. If you need language or sign language interpretation, tell the clinic staff. They can arrange for an interpreter to come to your appointment. If you need help getting to your appointment, call your DHS worker in advance. Your DHS worker may be able to help you get transportation. 7

9 If you cannot keep your appointment Call your PCD as soon as you can and tell them you cannot keep your appointment. The office will reschedule your appointment and make the cancelled time available for someone else. If you miss too many appointments, your PCD may dismiss you as a patient. Interpreter services If you are hearing or sight impaired or need help understanding or speaking English, your provider will arrange interpreter services for you. You may also call ODS Customer Service for help. When calling ODS, tell our Customer Service representative what language you speak and he or she will get an interpreter on the phone to help you. Referrals for specialty care If you need specialty care, your PCD will decide whether you should see another provider and will write a referral. ODS must approve the referral before you can go to your appointment. Prior authorization Some services do require a referral and/or prior authorization from ODS. Your PCD will contact ODS to request authorization for these services: Out-patient hospital dental services Oral surgery All specialist services Some services do not require a referral or prior authorization, and you can see any ODS plan provider. These are some examples: Pediatric dentist (may be your child s PCD) Denturist care After-hours dental care Call your PCD after hours for urgent or emergency dental conditions only. If you need dental attention or advice when your PCD s office is closed, call the PCD clinic phone number. There will be an answering service or instructions on how to reach your dentist in case of an emergency. Identify yourself as an ODS OHP member. You will be given advice, a referral or treatment right away. For routine advice and appointments, call your PCD s office during business hours. Urgent dental care 8

10 An urgent dental condition is serious enough to be treated right away but does not require emergency room care. If you have an urgent dental problem, call your PCD s office. Examples of urgent dental conditions are: A toothache Swollen gums A lost filling It can take up to two weeks to get an appointment for an urgent condition. When you call or visit your dentist s office, the dentist will decide how to treat you and make an appointment based on your needs. Emergency dental care Emergency care is covered 24 hours a day, seven days a week. In a dental emergency, call your dentist day or night. Speak to the dentist on call even if he or she is not your primary dentist. You don t need prior authorization to get emergency care. A dental emergency, like the following examples, requires immediate treatment: A tooth has been knocked out You have severe swelling or infection in the mouth You have severe tooth pain (pain that keeps you from sleeping, or does not stop when you take over-the-counter medicine such as aspirin or Tylenol) If you go to the emergency room for non-emergency services, you may be responsible for the follow-up care. You should call your PCD s office to schedule any follow-up care you need. Emergency dental care away from home For an emergency while you are away from home, call ODS before you get services, if possible. If you receive emergency dental care out of the area have the dentist send us a detailed bill and chart notes showing a dental emergency. Information must show that a dentist on our Plan was not available to provide the dental care. Covered OHP services to stabilize the emergency will be considered. Follow-up care is NOT an emergency. Call your primary care dentist for follow-up care, if needed. OHP BENEFITS AND SERVICES Non-covered services Not all dental care is covered. When you need care, contact your PCD. If you have questions about what your plan covers, call Customer Service at the number above. 9

11 If you receive a service that is not covered, you may have to pay the charges. You need to sign an agreement before your dentist can bill you. The agreement must: 1. Be signed before having any work done. 2. State the non-covered services you want to have done. 3. The cost you agree to pay for the services. Remember, if you get non-emergency or non-urgent services from a non-ods provider, you may be billed for the charges. The following services are not covered: Porcelain crowns on back teeth Buy-ups A buy-up is when a member pays the difference between an item OHP covers and a more expensive, non-covered model. For example, OHP may cover a steel crown, but a member wants a more expensive crown that is not covered. The member tries to buy up by paying the difference between what OHP covers and what the dentist charges. This is not allowed. If a noncovered service is performed, OHP will not pay any amount on it. OHP Plus The OHP Plus plan has different benefits for two different groups. Pregnant women and members under 21 years old: These OHP Plus members are covered for the full range of dental services, including preventive and restorative care. Non-pregnant women and members 21 years and older: These OHP Plus members are covered for preventive care and some restorative care, as explained below. Preventive care Both OHP Plus plans cover preventive care. Your PCD will provide general dental care and preventive care, which includes routine exams, X-rays and cleanings. Be sure to talk to your dentist about your schedule for checkups. Preventive services include: Exams, cleanings (prophylaxis) and fluoride, twice in any 12-month period Bitewing X-rays, once in any 12-month period Full mouth X-rays or panoramic films, once every five years Sealants, covered for members 15 years old or younger, on permanent molars (back teeth) once every five years; see the tooth chart on page 12 Other covered services 10

12 You are covered for other services, as listed below. There are some differences depending on your age and whether or not you are pregnant. Fillings (amalgam and composite resin restorations) Extraction of teeth that are infected or abscessed, causing severe tooth pain or unusual swelling of the face or gums Root canal therapy for the anterior (front) teeth and bicuspids (the two molars closest to the front of the mouth) for all members Root canal therapy for first and second molar teeth (2, 3, 14, 15, 18, 19, 30, 31) if you are under 21 Root canal therapy for first molar teeth (3, 14, 19, 30) if you are 21 years old or older AND you are pregnant. Stainless steel crowns for posterior (back) teeth once every five years if you are under 21 or pregnant Permanent crowns for anterior (front) teeth if you are under 21 or pregnant; you are allowed four permanent crowns in a seven-year period Partial dentures, if you are missing one or more anterior (front) teeth or six or more posterior (back) teeth; replacement once every 10 years Complete and immediate dentures if you are 16 or older Complete dentures are allowed once per lifetime and covered only if they are placed within six months of your last extracted tooth (lower or upper arch). If you have a partial denture, your complete denture will be covered only if it has been at least 10 years since you had your partial denture. Prescription medications Your OHP medical plan (not your dental plan) covers required prescription medications ordered by your PCD. OHP Standard The OHP Standard plan has limited benefits. Services are covered only when you have a dental emergency. Call Customer Service at (TDD/TTY: 711) if you have questions about what your plan covers. See benefit information in the chart on the following pages. 11

13 OHP Dental covered and non-covered services chart Dental service Pregnant women and members under 21 Non-pregnant women and members 21+ Standard members Covered Covered Covered ROUTINE & PREVENTIVE Routine exam Twice in 12 months Twice in 12 months No Routine cleaning Twice in 12 months Twice in 12 months No Fluoride Twice in 12 months Twice in 12 months No Routine bitewing x-rays Once in 12 months Once in 12 months No Full mouth x-ray Once in 5 years Once in 5 years No Sealants 15 or younger, molars only, once in 5 years EMERGENCY Emergency exam Yes Yes Yes Emergency x-rays Yes Yes Yes RESTORATIVE Amalgam fillings Yes Yes No Composite fillings Yes Yes No Retreat root canal therapy For anterior teeth For anterior teeth No Root canal therapy Stainless steel crowns Permanent crowns For anterior, bicuspid and 1 st and 2 nd molar teeth for members age 20 and younger For anterior, bicuspid and 1 st molar teeth for pregnant members age 21 and older For posterior teeth, once in 5 years Anterior teeth only (6, 7, 8, 9, 10, 11, 22,23,24,25,26 & 27) Limit 4 teeth in 7 years If missing 1+ anterior or 6+ posterior teeth No For anterior and bicuspid teeth (no molars) Partial dentures If missing 1+ anterior No or 6+ posterior teeth Partial denture replacement Once in 10 years Once in 10 years No Complete and immediate No dentures If over 16 years old, once per lifetime if received within 6 months of last extracted tooth in lower or upper arch. No No If over 16 years old, once per lifetime if received within 6 months of last extracted tooth in lower or upper arch. No No No No If you have a partial, a complete denture is covered only if it has been 10 years since 12 If you have a partial, a complete denture is covered only if it has been 10 years since

14 EXTRACTIONS Extraction of teeth that are abscessed or causing severe pain or swelling of face & gums receiving the partial. receiving the partial. Yes Yes Yes For additional services, call Customer Service at Tooth chart Upper arch Lower arch Primary Permanent Primary Permanent Description of tooth tooth # tooth # tooth # tooth # rd molar (wisdom tooth) nd molar st molar A 4 K 20 2nd bicuspid (premolar) B 5 L 21 1st bicuspid (premolar) C 6 M 22 Cuspid (canine/eye tooth) D 7 N 23 Lateral incisor (anterior) E 8 O 24 Central incisor (anterior) F 9 P 25 Central incisor (anterior) G 10 Q 26 Lateral incisor (anterior) H 11 R 27 Cuspid (canine/eye tooth) 13

15 I 12 S 28 1st bicuspid (premolar) J 13 T 29 2nd bicuspid (premolar) st molar nd molar rd molar (wisdom tooth) MEMBER RIGHTS AND RESPONSIBILITIES As a member of ODS OHP, you have the right to: Be treated with dignity, respect and consideration for your privacy. Be treated by participating providers the same as other people seeking healthcare benefits to which they are entitled. Select or change primary care dentists (PCD). Refer yourself to mental health, chemical dependency or family planning services without getting a referral from a PCP or other provider. Have a friend, family member or advocate present during appointments and at other times as needed, within clinical guidelines. Be actively involved in your treatment plans. Be given information about your conditions and covered and non-covered services, so you can make an informed decision about treatment. Consent to treatment or refuse services, and be told the consequences of that decision, except for court ordered services. Receive written materials describing rights, responsibilities, benefits available, how to access services and what to do in an emergency. Have written materials explained in a way you can understand. Receive necessary and reasonable services to diagnose your conditions. Receive covered services under the Oregon Health Plan that meet generally accepted standards of practice and are medically appropriate. Receive covered preventive services. Access urgent and emergency services 24 hours a day, seven days a week. Receive a referral to specialty providers for appropriate covered services. Have a clinical record that lists conditions, services received and referrals. Have access to your own clinical record, unless restricted by statute, and request and receive a copy of your dental records and request that they be amended or corrected. Transfer a copy of your clinical record to another provider. Execute a statement of wishes for treatment (advance directive), including the right to accept or refuse medical, surgical, chemical dependency or mental health treatment and the right to obtain a power of attorney for healthcare. Receive written notices before a denial of, or change in, a benefit or service, unless notice is not required by federal or state regulations. 14

16 Know how to make a complaint or appeal about care or your plan. Request an administrative hearing with DHS. Receive interpreter services. Receive a notice of an appointment cancellation in a timely manner. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation and to report any violations to ODS or to the Oregon Health Plan. Post-stabilization services after you visit an emergency department. A second dental opinion. As a member of ODS OHP, you must: Choose, or help with assignment to, a provider or clinic, once enrolled. Treat all providers and their staff with respect. Be on time for appointments and call in advance to cancel an appointment or if you expect to be late. Seek periodic health exams and preventive care from your PCD. Use your PCD or clinic for diagnostic and other care, except in an emergency. Get a referral to a specialist from your PCD before seeking care from a specialist, unless self-referral is allowed. Use urgent and emergency services appropriately and notify ODS within 72 hours of an emergency. Give accurate information for your clinical record. Help your provider get clinical records from other providers. This may include signing a release of information form. Ask questions about conditions, treatments and other issues related to your care that you do not understand. Use information to make decisions about treatment before it is given. Help create a treatment plan with your provider. Follow prescribed, agreed-upon treatment plans. Tell providers that your healthcare is covered under the Oregon Health Plan before services are received and, if requested, show your provider your DHS Medical Care ID card. Tell your DHS worker when you change your address or phone number. Tell your DHS worker if you become pregnant and when your child is born. Tell your DHS worker if any family members move in or out of your home. Tell your DHS worker if you have any other insurance available. Pay for non-covered services received. Pay any monthly OHP premium on time. Help ODS pursue any third-party resources available and pay ODS the amount of benefits paid from any settlement received from an injury. 15

17 Bring issues, complaints or grievances to the attention of ODS or DHS Division of Medical Assistance Programs (DMAP). Sign an authorization to release your medical information so that ODS can get information to respond to an administrative hearing request. COMPLAINTS AND APPEALS If you are not satisfied with the care from your dental provider or service from ODS, you can file a complaint. If you receive a denial and you do not agree with the decision, you can file an appeal or request an administrative hearing. A denial is a decision to not pay for, not provide or stop paying for a service. If you need help filing a complaint, an appeal or an administrative hearing request, call ODS at the number below and we will help you. You also may call your caseworker for help or the Public Benefits Hotline (a program of Legal Aid Services of Oregon and the Oregon Law Center) at (TDD/TTY: 711) for advice and possible representation. Legal Aid Services of Oregon information can also be found at Complaints To file a complaint, call ODS OHP Dental Customer Service or write: ODS Health Plans Telephone: Attn: Appeal Unit or SW Second Ave. TDD/ Portland, OR ODS will get back to you in five working days to tell you that we have received your complaint, provide our decision or explain any delay. ODS will respond to your complaint within 30 calendar days of receiving it. You may need to give ODS your consent to review the complaint and request your medical records. All information about your complaint is handled confidentially. If you are not satisfied with the response to your complaint, you can file a complaint with the state of Oregon by writing to: Department of Human Services Governor s Advocacy Office 500 Summer St. NE, E17 Salem, OR Telephone: TDD/TTY:

18 Appeals As an OHP member, you or your provider may challenge a denial of coverage or payment for medical assistance through an appeal. To file an appeal, you or your provider can call ODS OHP Dental Customer Service within 45 days of the date of the denial. To file in writing, complete an ODS OHP appeal form. You should have received this form with your denial. If you or your provider calls in an appeal, you or your provider must follow up with a written, signed appeal, using the ODS OHP appeal form. Call or write: ODS Health Plans Telephone: Attn: Appeal Unit or SW Second Ave. TDD/ Portland, OR ODS will get back to you in five calendar days to tell you that we have received your appeal, provide our decision or explain any delay. ODS will complete the review and respond to your appeal within 16 calendar days. If ODS cannot resolve your complaint within 16 calendar days, you will receive another letter explaining the delay. Your complaint will be resolved within 14 calendar days of the date the original 16 calendar days ended. If you believe your problem is an emergency and cannot wait for a review, ask ODS for an expedited or rush appeal. If ODS agrees that your appeal is an emergency, ODS will respond to your request within three working days. You may need to give ODS permission to look into your appeal and see your medical records. All information about your appeal is kept private. If you do not agree with our response to your appeal, you can ask for an administrative hearing. You can ask for an appeal and a hearing at the same time. You have the right to continue services during the appeal process, but you will have to pay for those services if the denial is upheld. OHP administrative hearings To request an administrative hearing, call ODS or your DHS worker within 45 days of the date of the denial. Call ODS at or (TDD/) and request a Notice of Hearing Rights instruction form (DMAP 3030) and an Administrative Hearing Request form (DHS 443). You should have received these forms with a copy of your denial. 17

19 Read the Notice of Hearing Rights instruction form completely. The instructions give important information, such as how to request a rush hearing and how to continue services during the hearing process. Complete the Administrative Hearing Request form and return it to DMAP, your DHS worker or the nearest DHS office within 45 days of the date of the denial. You have the right to continue services during the hearing process, but you will have to pay for those services if the appeal denial is upheld. You also have the right to have a representative help you with the hearing. A representative may be your healthcare representative, guardian, spouse or other family member, support team or your DHS worker. OTHER IMPORTANT INFORMATION Changes to your address or phone number If you move or change your phone number, tell your PCD s office and your DHS worker to make sure you keep getting important information from ODS. Privacy Any information in your ODS or dental office record and anything you discuss with your provider, their staff and ODS is kept private. Information in these records will not be shared without your approval, except with DMAP. How to get copies of your dental records Each provider keeps a record that lists your dental conditions, services provided and referrals. You have the right to request and receive copies of your dental records (the provider may charge a reasonable copying fee). You also have the right to request that your records be amended or corrected. Call your dental provider to request your records, and call ODS if you need help getting a copy. If you become pregnant If you become pregnant, call your DHS worker right away. Your DHS worker will make sure you do not lose your coverage. If you are pregnant, or think you might be, it is important that you see a healthcare provider right away. Regular check-ups are important to having a healthy baby. Call your DHS worker as soon as your baby is born. Your DHS worker will enroll your baby in the Oregon Health Plan. Non-emergency transportation 18

20 You may be able to get help with transportation if you have no way to get to a dental appointment. Call your DHS worker in advance to arrange for transportation. Help with quitting tobacco use Services to help you quit using tobacco are a covered benefit for all OHP members through your OHP medical plan. Call your primary care provider or your OHP medical plan customer service and tell them you would like help. Member disenrollment request OHP members may ask to change managed care plans at certain times. If approved, the change will take effect on the first of the month following DHS approval. Talk to your caseworker about changing plans. Plan disenrollment request The following may cause you to lose your ODS coverage: Losing your eligibility through the Oregon Health Plan Moving out of the ODS service area Committing fraudulent or illegal acts Being abusive to staff or property DMAP Oregon Health Plan Client Handbook Refer to the DMAP Oregon Health Plan Client Handbook for additional information on the Oregon Health Plan that may not be included in this handbook. Call the OHA Statewide Medical Processing Center at , TTY , to have a copy mailed to you. You can read it online at INFORMATION AVAILABLE UPON REQUEST ODS Community Health, Inc. If you would like information about The ODS Companies structure and operation, visit our website at or call ODS Customer Service at (TDD/). Physician reimbursement You are entitled to ask if ODS has special financial arrangements with our participating dentists that can affect the use of referrals and other services. Call Customer Service for information about our physician payment arrangements. THE ODS PROVIDER DIRECTORY The following pages list the dentists who participate in the ODS OHP dental plan. The list includes: 19

21 Participating general dentists (primary care dentists) Participating pediatric (children s) dentists Participating denturists (for dentures; does not apply to Standard plan) General dentists and pediatric dentists are listed in alphabetical order by county. If you are hearing or sight impaired or have difficulty understanding or speaking English, your dentist will coordinate interpreter services for you. ODS makes corrections, additions and deletions to its provider directory monthly. To make sure the provider you select still participates with ODS, go on online to our provider search at and click on Find Care or call Customer Service at or , TTY

22 Baker Elkhorn Denture Service 2535 Myrtle St Baker City, OR (541) Tatlock, Curtis F. LD 2535 Myrtle St Baker City, OR (541) Benson, Sean A. DDS st St Baker City, OR (541) Peters, Curtis A. DMD st St Baker City, OR (541) Sean A Benson st St Baker City, OR (541) Whitnah, Warren L. DMD 218 N Pine St Halfway, OR (541) Benton Denturist-OP Endorsement Baldwin, Kevin D. DDS 2300 NW Kings Blvd Corvallis, OR (541) Bhavan, Priya DDS 1112 NW Circle Blvd Corvallis, OR (541) Boys & Girls Club of Corvallis 1112 NW Circle Blvd Corvallis, OR (541) Brady, Melissa J. DMD 1112 NW Circle Blvd Corvallis, OR (541) Brock, Erin R. DMD 1112 NW Circle Blvd Corvallis, OR (541) Capitol Dental Group PC 1769 NW Kings Blvd Ste 8 Corvallis, OR (541) Davis, Stephen D. DDS 2300 NW Kings Blvd Corvallis, OR (541) Chinese Hata, Lenore S. DDS 2300 NW Kings Blvd Corvallis, OR (541) Johnson, Kenneth R. DMD 1112 NW Circle Blvd Corvallis, OR (541) Lindquist, Theresa J. DMD 1112 NW Circle Blvd Corvallis, OR (541) Tidwell, Brian D. DDS 2300 NW Kings Blvd Corvallis, OR (541) Clackamas Denturist-OP Endorsement Bens Denture Center Inc SE Proctor Sandy, OR (503) Bywaters, Kurt I. LD 3900 Douglas Way Lake Oswego, OR (503) Corbett Denture Service 300 NW 3rd Ave Canby, OR (503) Corbett, Steven G. LD 300 NW 3rd Ave Canby, OR (503) Great North West Smiles SW Boones Ferry Rd Wilsonville, OR (503) Randji, Akbar K. LD 279 Warner Milne Rd (503) Smith, Timothy A. LD SE Proctor Blvd Sandy, OR (503) Unsicker, John LD SW Boones Ferry Rd Ste E Wilsonville, OR (503) Adroit Family Dental 5493 Amy Street West Linn, OR (503) Bachhuber Jr, Thomas E. DMD 2236 SE Washington St Milwaukie, OR (503) Barnum, James B. DMD 2025 SE Washington St Milwaukie, OR (503) Baumgartner, Marie DDS SW Villebois Dr N Ste D Wilsonville, OR (503) Baumgartner, Paul M. DDS 128 E Ross St Molalla, OR (503) Bibb Jr, Russell E. DMD 103 SW Hwy 224 Ste A Estacada, OR (503) Biermann, Bruce A. DMD SE Pleasant St Sandy, OR (503) Booth, Jackson R. DDS SW Argyle Ave Ste F Wilsonville, OR (503) Brady, Melissa J. DMD S Molalla Ave (503) SE Campbell St Milwaukie, OR (503) Bullock, John A. DMD 9415 SW Wilsonville Rd Wilsonville, OR (503)

23 Caba, Nicholas P. DMD 1174 Molalla Ave (503) Canby Dental LLC 249 NW 3rd Ave Canby, OR (503) Careone Dental SE 82nd Ave Happy Valley, OR (971) Center Street Dental PC 1001 Molalla Ave Ste 110 (503) Chinn, Elliott H. DMD SE 202nd Ave Clackamas, OR (503) Chung, Kenneth L. DDS SE Oak St Ste 268 Milwaukie, OR (503) Chinese Clackamas County Community Health 1425 Beavercreek Rd (503) SE Sunnyside Road Ste 200 Clackamas, OR (503) ComfortCare Dental Mobile Health Services SE Oak St Ste 268 Milwaukie, OR (503) Comfortcare Dental SE Sunnyside Road Clackamas, OR (503) S Molalla Ave (503) SE Campbell St Milwaukie, OR (503) Compassion Family Dentistry 2025 SE Washington St Milwaukie, OR (503) Conklin, Derek W. DMD Shelley Ave Ste A Sandy, OR (503) Cook, Jonathan T. DDS 1001 Molalla Ave Ste 110 (503) Cook, Katherine DDS 9775 SE Sunnyside Road Ste 200 Clackamas, OR (503) Coombs, Caleb V. DMD SE Sunnyside Road Clackamas, OR (503) SE Campbell St Milwaukie, OR (503) Curtis, Thomas B. DMD 1820 Willamette Falls Dr West Linn, OR (503) Dennis T Adair DMD PC 15 82nd Dr Ste 240 Gladstone, OR (503) Dhadli, Jatinder S. DDS 175 Grange Ave Molalla, OR (503) Do, Liem D. DDS SE 82nd Ave Happy Valley, OR (971) Duffin, Steven R. DDS SW Villebois Dr N Ste D Wilsonville, OR (503) Edvalson, Timothy J. DMD 3900 Douglas Way Lake Oswego, OR (503) Eftekhari, Siavash DDS 3245 SE Campbell St Milwaukie, OR (503) El Youssef, Anthony M. DMD Shelley Ave Ste A Sandy, OR (503) Evans, Kendall S. DDS 1174 Molalla Ave (503) Gitelson, Lisa M. DMD SE McLoughlin Blvd Milwaukie, OR (503) SW Argyle Ave Unit F Wilsonville, OR (503) Goertz, James D. DMD 617 High St Ste 201 (503) Goh, Jia Lin DMD 2403 SE Monroe St Ste F Milwaukie, OR (503) Grasvik, Nicholas M. DMD SW Argyle Ave Ste F Wilsonville, OR (503) Gregson, N Dean DMD SE McLoughlin Blvd Milwaukie, OR (503) Hagler, C Steven DMD 300 N Holly St Canby, OR (503) Hahn, Kai-Uwe H. DMD 3245 SE Campbell St Milwaukie, OR (503) Harbolt, Timothy R. DMD 1174 Molalla Ave (503) Hazel, Michael C. DMD Willamette Dr West Linn, OR (503) Hill, Michael A. DMD 2636 SE Harrison Ste B Milwaukie, OR (503) John A Bullock 9415 SW Wilsonville Rd Wilsonville, OR (503)

24 Johnson, Daryl L. DMD 128 Ross St Molalla, OR (503) Kakishita, Lisa M. DMD SW Villebois Dr N Wilsonville, OR (503) Karim, Alamin DDS 249 NW 3rd Ave Canby, OR (503) Koenig, Ronald E. DMD 3315 SE Harrison St Milwaukie, OR (503) Kooning, Christopher D. DMD SE Mcloughlin Blvd Milwaukie, OR (503) Langford, Steven E. DMD 300 N Holly St Canby, OR (503) Lippert, Rodney C. DMD 7000 SE Thiessen Rd Milwaukie, OR (503) Love, April DDS S Beavercreek Rd (503) Lyubchenko, Dmitriy P. DMD SE McLoughlin Blvd Milwaukie, OR (503) Matzelle, Eric DMD SE McLoughlin Milwaukie, OR (503) McLean, Marianna J. DMD 128 Ross St Molalla, OR (503) Melby, William J. DMD 128 E Ross St Molalla, OR (503) Molalla Family Dental 128 Ross St Molalla, OR (503) Monroe Dental Care LLC 2403 SE Monroe St Ste F Milwaukie, OR (503) Morris, John A. DMD 1425 Beavercreek Rd (503) SE Sunnyside Road Ste 200 Clackamas, OR (503) NW Dental Clinic LLC 106 E 2nd St Molalla, OR (503) Neighborhood Health Center S Beavercreek Rd (503) Nguyen, Bruce L. DMD 1425 Beavercreek Rd (503) SE Sunnyside Road Ste 200 Clackamas, OR (503) Nguyen, Vinh C. DMD 1425 Beavercreek Rd (503) SE Sunnyside Road Ste 200 Clackamas, OR (503) OLoughlin, Cindy DDS SE McLoughlin Blvd Milwaukie, OR (503) SW Argyle Ave Ste F Wilsonville, OR (503) Oregon City Family Dentistry 602 Monroe St (503) Osmunson, Willard E. DDS SW Argyle Ave Ste F Wilsonville, OR (503) Plunkett, Michael L. DDS S Beavercreek Rd (503) Puffer, Paul J. DMD 106 E 2nd St Molalla, OR (503) Puffer, Steven F. DMD 106 E 2nd St Molalla, OR (503) Salathe, Olesya Z. DMD 106 E 2nd St Molalla, OR (503) Sawyer, Joseph A. DMD 205 Portland Ave Gladstone, OR (503) Shumate, Joe A. DMD Pleasant Ave Sandy, OR (503) Smirnoff, Kirill A. DMD 5493 Amy Street West Linn, OR (503) Smith, Kyle C. DMD 602 Monroe St (503) Spitze, Raini DDS South Redland Rd (503) Stirewalt, Charles E. DDS SE McLoughlin Blvd Milwaukie, OR (503) SW Argyle Ave Ste F Wilsonville, OR (503) Strohschein, Marvin J. DDS S Beavercreek Rd (503) Suk, Petrina DDS 3245 SE Campbell St Milwaukie, OR (503) Taylor-Smith, Annalisa DDS 602 Monroe St (503) Thomas E Bachhuber Jr DMD 2236 SE Washington St Milwaukie, OR (503) Villebois Dental LLC SW Villebois Dr N Ste D Wilsonville, OR (503) Westermeyer, Sara DDS SE Industrial Way Ste A Sandy, OR (503)

25 Westover, Brian R. DMD SE McLoughlin Milwaukie, OR (503) Wikle, Aaron L. DMD Shelley Ave Ste A Sandy, OR (503) SW Parkplace Ste A Wilsonville, OR (503) Dental Hygienist w/ special Brawand, Cindy L. RDH Gaffney Lane (503) Kelly, Laurie L. RDH 109 2nd Street Canby, OR (503) SE River Rd (503) S Mollalla Ave (503) S Longview Way (503) Neighborhood Health Center S Beavercreek Rd (503) Nelson, Sandra C. RDH SE 127th Clackamas, OR (503) Pediatric Dentist Dentistry for Kids SW Parkplace Ste A Wilsonville, OR (503) James, Dustin R. DMD SW Parkplace Ste A Wilsonville, OR (503) Kennard, Monica DDS 911 Main St Ste 140 (503) Clark Deochand, Lenard G. LD 2802 Columbia St Vancouver, WA (360) Clatsop James H Tyack DMD PC th St Astoria, OR (503) Smith, Scott A. DDS th St Astoria, OR (503) Columbia Grim, Jeffrey D. DDS 575 S Columbia River Hwy Saint Helens, OR (503) Irene Glanville DMD 101 5th St W Rainier, OR (503) James H Tyack DMD PC 400 SW Bel Air Dr Clatskanie, OR (503) Scheuerman, Christopher M. DMD 622 Bridge St Vernonia, OR (503) Smith, Scott A. DDS 400 SW Bel Air Dr Clatskanie, OR (503) Coos Denturist-OP Endorsement Denturist-OP Endorsement Community Dental Lab PC 2495 Newmark St North Bend, OR (541) Simon, Samie C. LD 2495 Newmark St North Bend, OR (541) Curry Mayo, Kismet A. LD 1041 Chetco Ave Brookings, OR (541) Deschutes Denturist-OP Endorsement Denturist-OP Endorsement Burzynski, Tad W. LD 853 NE 4th St Bend, OR (541) Robirts, Wade L. LD 600 NE Savanna Dr Ste 2 Bend, OR (541) Capitol Dental Group PC 1201 NW Wall Street Suite 102 Bend, OR (541) Frisinger, Kyle J. DMD 834 SW 11th St Chelsea Square #3 Redmond, OR (541) Jensen, Mark E. DMD 199 SW Shevlin Hixon Dr Ste A Bend, OR (541) Kyle J Frisinger DMD PC 834 SW 11th St Chelsea Square #3 Redmond, OR (541) Northwest Dental Group PC Bluewood Pl La Pine, OR (541) Wold, Thomas E. DMD 124 NW Hawthorne Ave Bend, OR (541)

26 Yang, Jonathan DDS Bluewood Pl La Pine, OR (541) Dental Hygienist w/ special Downs, Cindy L. RDH Steens Mountain Loop Bend, OR (541) Robinson, Linda K. LAP Clear Night Dr Bend, OR (541) Burrus, Elise P. DDS 1820 NW Monterey Pines Ste 200 Bend, OR (541) NW Larch Ave Ste 201 Redmond, OR (541) Ford, James J. DDS 1820 NW Monterey Pines Ste 200 Bend, OR (541) Lynch, Theodore R. DDS 750 NW Charbonneau St Ste 101 Bend, OR (541) Pediatric Dental Associates Central Oregon 1820 NW Monterey Pines Ste 200 Bend, OR (541) Vaikuntam, Jay DDS 1820 NW Monterey Pines Ste 200 Bend, OR (541) NW Larch Ave Ste 201 Redmond, OR (541) Douglas Pediatric Dentist Galloway, Robert S. DMD 900 W Military Ave Roseburg, OR (541) Larson, Robert L. DDS 1333 W Harvard Ave Roseburg, OR (541) Schmutz, Jared W. DMD 1683 W Harvard Ave Roseburg, OR (541) W Harvard Roseburg, OR (541) Hood River Denturist-OP Endorsement Chapman, Chris R. LD th St Hood River, OR (541) Anderson, Margaret E. DDS 419 State St Ste 4 Hood River, OR (541) Aughney, Elizabeth A. DDS 849 Pacific Ave Hood River, OR (541) Burton, Bruce A. DMD th St Ste 1 Hood River, OR (541) Geelan, Aron T. DDS 849 Pacific Ave Hood River, OR (541) Nadelhoffer, Evonne M. DDS 849 Pacific Ave Hood River, OR (541) Taylor, David V. DMD 1835 Belmont Ave Hood River, OR (541) Pediatric Dentist Swisher, Christopher A. DDS 419 State St Ste 4 Hood River, OR (541) Jackson Denturist Western Denture Center Inc 1055 Court St Ste B Medford, OR (541) Denturist-OP Endorsement ADC Dental Clinic 720 Bennett Ave Medford, OR (541) Helvey, Diana K. LD 590 Blackstone Aly Jacksonville, OR (541) Schroeder, Robert D. LD 832 E Main St Ste 10 Medford, OR (541) Valley Denture Care 590 Blackstone Aly Jacksonville, OR (541) Barsalou, Luke T. DMD 1113 Progress Dr Medford, OR (541) Hamrick Rd Central Point, OR (541) Capitol Dental Group PC 826 E Main Street Medford, OR (541) Town Centre Drive Ste B Medford, OR (541) Coombs, Caleb V. DMD 832 E Main St Ste 10 Medford, OR (541) Fine, Amy B. DMD 1113 Progress Dr Medford, OR (541) Getsinger, Philip DDS 1113 Progress Dr Medford, OR (541)

27 Kittelson, Ian T. DDS 1113 Progress Dr Medford, OR (541) La Clinica Del Valle 1113 Progress Dr Medford, OR (541) Hamrick Rd Central Point, OR (541) Layer, David R. DMD 4940 Hamrick Rd Medford, OR (541) Prins, Brian L. DMD 832 E Main St Ste 10 Medford, OR (541) Roa, Calie DDS 4940 Hamrick Rd Central Point, OR (541) Siskiyou Dental Associates 2665 Siskiyou Blvd Medford, OR (541) Southern Oregon Denture and Dental 832 E Main St Ste 10 Medford, OR (541) Spencer, David A. DDS 2692 N Pacific Hwy Medford, OR (541) Starley, Matthew DDS 4940 Hamrick Rd Central Point, OR (541) Uso III, Madrid DDS 832 E Main St Ste 10 Medford, OR (541) Dental Hygienist w/ special Healthy Smiles Happy Hearts LLC Hwy 62 Eagle Point, OR (541) Martin, Pamela S. RDH Hwy 62 Eagle Point, OR (541) Smiles R4ever 711 Medford Center #392 Medford, OR (541) Smith, Cheryl A. RDH LAP 711 Medford Center #392 Medford, OR (541) Pediatric Dentist Frimkess, Steven A. DDS 1150 Crater Lake Ave Ste C Medford, OR (541) Jefferson Dehm, Gary E. DMD 48 NE 11th St Madras, OR (541) Higbee, TJ DDS 48 NE 11th St Madras, OR (541) Toms, Andrew S. DDS 611 SE 5th St Madras, OR (541) Josephine Denturist-OP Endorsement River City Denture and Dental 1010A NE 7th St Ste A Grants Pass, OR (541) Schroeder, Robert D. LD 1010A NE 7th St Ste A Grants Pass, OR (541) Bright Now Dental 1021 NE 6th St Grants Pass, OR (541) Capitol Dental Group PC 1201 NE 7th St Ste A Grants Pass, OR (541) Castle, Kenneth F. DDS 1035 NE 6th St Ste B Grants Pass, OR (541) Coombs, Caleb V. DMD 1010 NE 7th St Ste A Grants Pass, OR (541) Dentex PC 1201 NE 7th St Ste D Grants Pass, OR (541) Erickson, Sten DMD 1035 NE 6th Street Ste B Grants Pass, OR (541) Lillian, David DDS 1035 NE 6th St Ste B Grants Pass, OR (541) Mudrow, Kevin R. DDS 1035 NE 6th St Ste B Grants Pass, OR (541) Sanford, Ross E. DDS 1010 A NE 7th St Grants Pass, OR (541) Siskiyou Community Health Center 1035 NE 6th Street Ste B Grants Pass, OR (541) Stirewalt, Charles E. DDS 1021 NE 6th St Grants Pass, OR (541) Tudor III, Blair J. DMD 1010 NE 7th St Ste A Grants Pass, OR (541) Uso III, Madrid DDS 1010 A NE 7th St Grants Pass, OR (541) White, Brandon A. DDS 1021 NE 6th St Grants Pass, OR (541) Zdun, Terry F. DDS 1201 NE 7th St Ste D Grants Pass, OR (541)

28 Gerd S Taylor Rdh 5550 Upper River Rd Grants Pass, OR (541) Taylor, Gerd S. RDH LAP 5550 Upper River Rd Grants Pass, OR (541) Klamath Klamath Tribal Health & Family Services 330 Chiloquin Blvd Chiloquin, OR (541) Masaitis, Anita M. DMD 330 Chiloquin Blvd Chiloquin, OR (541) Ngo, Thuc DMD 330 Chilquin Blvd Chiloquin, OR (541) Spencer, Wendy J. DMD 330 Chiloquin Blvd Chiloquin, OR (541) Walker, Edward S. DDS 330 Chilquin Blvd Chiloquin, OR (541) Alex, David M. DMD 330 Chiloquin Blvd Chiloquin, OR (541) Lane Dental Hygienist w/ special Pediatric Dentist Denturist-OP Endorsement Johnson, Joyce D. LD th St Ste 6 Springfield, OR (541) Murray, Shawn LD 202 E 14th Ave (541) Quigley, Joseph D. LD 74 E 18th Ave Ste 6 (541) Tatos Dental Lab Hwy 99 S Cottage Grove, OR (541) Tatos, John LD Hwy 99 S Cottage Grove, OR (541) Bagaason, Michael A. DMD 175 W B St Springfield, OR (541) Bratland, Michael J. DMD 5892 Main St Ste 4 Springfield, OR (541) Bumstead, H Martin DDS 3467 Hilyard St Ste B Eugene, OR (541) Dutch Cadaret, Alison T. DDS 498 Harlow Rd Ste 5 Springfield, OR (541) Cantrell, Carolyn M. DMD 2233 Willamette St Ste B Eugene, OR (541) Capitol Dental Group PC 1680 Chambers Road Ste 204 Eugene, OR (541) Q Street Springfield, OR (541) Coburg Road Ste 104 (541) Country Club Rd Ste C100 (541) Carmichael, Robert A. DDS 401 E 10th Ave Ste 300 (541) Carpenter, Gary E. DMD 401 E 10th Ave Ste 210 (541) Churchill Plaza Dental 2101 Bailey Hill Rd Ste D Eugene, OR (541) Clark, Tyler D. DMD 27 W 17th Ave (541) Contreras Jr, Sixto DMD 1400 Mill St (541) CrisDental Eugene LLC 2377 Oakmont Way (541) CrisDental Thurston LLC 5892 Main St Ste 4 Springfield, OR (541) David L Weiss DDS PC 175 W B St Bldg G Springfield, OR (541) David R Matthews DMD 2201 Willamette St Ste A Eugene, OR (541) Del Valle, Mercedes R. DDS 388 High St (541) Dose, Stephen J. DMD 1745 W 17th Ave Eugene, OR (541) Fenton, David S. DDS 4120 Qwest Dr Eugene, OR (541) Foshay, Jonathan G. DMD 1021 Juniper St Junction City, OR (541) Gabriel, Richard B. DDS 717 Country Club Rd (541)