FDCi Membership

FDCi Member Complaints

An FDCi Member has the right to file a complaint in writing or by telephone. A completed complaint form may be:

• Mail to:
Family Dental Care, Inc.
ATTN: Appeals & Grievances
6700 SW 105th Avenue Suite 210
Beaverton, Oregon 97008

• faxed to 503.644.6488

• sent electronically through our secure web form. FDCi does not accept any personal member information received through unsecure or unencrypted service.

To submit a complaint by phone call FDCi Customer Service at 503.644.2663 TTY 711 or 1.888.350.0996. Download the OHP Complaint Form in your preferred language.

OHP Complaint Form – English

OHP Complaint Form – Spanish

OHP Complaint Form – Vietnamese

OHP Complaint Form – Russian

FDCi Member Appeal Requests

An FDCi Member has the right to file an appeal request within 60 days of the effective date of a Notice of Action. Completed appeal forms and/or administrative hearing requests may be:

• Mail to:
Family Dental Clinic, Inc.
ATTN: Appeals & Grievances
6700 SW 105th Avenue Suite 210
Beaverton, Oregon 97008

• faxed to 503.644.6488

• sent electronically through our secure web form. FDCi does not accept any personal member information received through unsecure or unencrypted service.

To submit an appeal request by phone you can call FDCi Customer Service at 503.644.2663 TTY 711 or 1.888.350.0996. Download the OHP Denial of Medical Services Appeal and Hearing Request Form below in your preferred language.

OHP Appeal & Hearing Request Form – English

OHP Appeal & Hearing Request Form – Spanish

OHP Appeal & Hearing Request Form – Vietnamese

OHP Appeal & Hearing Request Form – Russian

FDCi Member Administrative Hearing Requests

If an FDCi Member does not agree with the results of an appeal request they can request an administrative hearing. An administrative hearing cannot be requested until an appeal has been completed.

An FDCi Member has the right to file an administrative hearing request within 120 days of the effective date of a Notice of Appeal Resolution. Completed administrative hearing requests may be:

• Mail to:
Family Dental Clinic, Inc.
ATTN: Appeals & Grievances
6700 SW 105th Avenue Suite 210
Beaverton, Oregon 97008

• faxed to 503.644.6488

• sent electronically through our secure web form. FDCi does not accept any personal member information received through unsecure or unencrypted service.

To submit an administrative hearing request by phone you can call FDCi Customer Service at 503.644.2663 TTY 711 or 1.888.350.0996. Download the OHP Denial of Medical Services Appeal and Hearing Request Form below.

Download Form

As an FDCi Member, You Have the Right To...

  • To be treated with dignity, respect and a consideration for privacy;

  • To not be discriminated against;

  • To be treated by participating providers the same as other people seeking dental services;

  • To choose a Primary Care Dentist (PCD) and change to another PCD in accordance with OAR 410-141-0080;

  • To obtain a second opinion at no-cost to the Member. A second opinion will be from a state licensed and qualified dental professional. It is preferable that a Member seek an FDCi Dental Provider from the FDCi Dental Provider Network. However, if this is not an option for the Member, they may seek an out-of-network dental provider at no-cost, following approval from the FDCi Dental Director;

  • To have a friend, family member, or advocate with you during appointments and other times as needed within clinical guidelines;

  • To be actively involved in the development of your treatment plan;

  • To be given information about covered and non-covered services to make an informed decision about proposed treatment;

  • To consent to treatment or refuse dental services, and to be advised of the consequences of that decision, except for court ordered services;

  • To receive written materials describing rights, responsibilities, covered benefits, accessing services and what to do in an emergency;

  • To have the information explained in a manner that is understandable;

  • To receive necessary and reasonable services to diagnose your condition;

  • To receive covered services under the Oregon Health Plan (OHP) that meet generally accepted standards of practice and are dentally appropriate;

  • To obtain covered preventative services;

  • To have access to urgent and emergency services 24 hours a day, 7 days a week;

  • To ask if FDCi has special financial arrangements with FDCi Providers which can affect the services you may need. Call FDCi to request this information;

  • To receive a referral of specialty providers for dentally appropriate, covered services;

  • To have a clinical record maintained which documents conditions, services received, and referrals made;

  • To have access to your own clinical record, unless your doctor thinks it's bad for you;

  • To send a copy of your record to another provider;

  • To make a statement of wishes for treatment and obtain a power of attorney for dental care;

  • To receive written notice before a service is denied, stopped or reduced;

  • To be informed on how to make a complaint or appeal and receive a response from FDCi;

  • To request an Administrative Hearing with the Department of Health and Human Services (DHS);

  • To receive notice from your provider of an appointment cancellation in a timely manner;

  • To receive interpreter services;

  • To receive information on the structure and operation of our organization and whether our providers are paid to limit services. FDCi does not have any incentive plans with any providers;

  • To be free from any form of restraint or seclusion used to force, discipline, or punish you, or to make your treatment easier, as specified in Federal regulations on the use of restraints and seclusion;

  • To have written materials explained in a manner that is understandable to the member.

  • FDCi prohibits clinics or providers from encouraging a member to withdraw a Grievance which is already filed.

  • FDCi prohibits punitive action against a Provider for supporting a member’s Grievance.

Family Dental Care, Inc. must follow state and federal civil rights laws. We cannot treat people unfairly in any of our programs or activities because of a person’s: age, color, disability, gender identity, genetic information, marital status, national origin, pregnancy, race, religion, sex, sexual orientation, veteran, or whistle-blower status. If you feel you were treated unfairly for any of these reasons in addition to filing a complaint with Family Dental Care, Inc. you may contact Oregon Health Authority’s civil rights manager.  You can do so in one of these ways:

Web: www.oregon.gov/OHA/OEI

Email: OHA.PublicCivilRights@dhsoha.state.or.us

Phone: 844-882-7889, TTY 711

Mail: OHA Office of Equity and Inclusion 421 SW Oak St., Suite 750 Portland, OR 97204

Family Dental Care, Inc. and our providers believes it is important that the dental care we provide value and respect the diversity of our members.  We will strive to deliver care that is both culturally and linguistically responsive to the needs of our members.

Suspected Fraud, Waste and Abuse

FDCi is funded by the state and federal governments. We take cases of Fraud, Waste and Abuse seriously.

Question: Who can report Fraud, Waste and Abuse? Answer: Anyone, including:

  • Patients
  • Providers
  • Staff

How to report Fraud, Waste and Abuse:

  • Call the FDCi Compliance Department toll free at 1-888-350-0996, or local at 503-644-2663 option 4; or
  • Send a confidential email using the Contact Us section of this website.