Welcome to your Family Dental Care Inc., Dental Plan We are so happy to have the opportunity to serve your dental needs.

You can view and download our Welcome Letter below to start learning more about our dental network.

Your Family Dental Care Member Handbook

Download or read your copy of our Member Handbook online for detailed information on how you can get the most out of your dental care.

You can download and save or print your Member Handbook, download and save or print our large print copy, or you may view and read it directly on our website. See these options below.
*Our member handbook is also available in other formats. To request a member handbook in large print, a different language, or in another format at no cost to you, call Customer Service at +503-644-2663, or Toll Free at 1-888-350-0996/TTY 711  or email us at quality@familydentalcareinc.com
Member Handbook Download

Large Print Member Handbook Download

Online Readable Member Handbook

If you prefer to read our Member Handbook on our website instead of downloading it, click here to view it on our website. We also have the option to listen to it on our website here.

Clinic Locations

To make an appointment please view our clinic directory for available providers.

Transitions of Care

Download a copy of our transitions of care policies and procedures. *Our transitions of care policies and procedures is also available in other formats. To request the file in large print, a different language, or in another format at no cost to you, call Customer Service at 503-644-2663, or Toll Free at 1-888-350-0996/TTY 711  or email us at quality@familydentalcareinc.com

Member Handbook Click here for more information

Download a copy of our Member Handbook for detailed information on how you can get the most out of your dental care.

*Our member handbook is also available in other formats. To request a member handbook in large print, a different language, or in another format at no cost to you, call Customer Service at 503-644-2663, or Toll Free at 1-888-350-0996/TTY 711  or quality@familydentalcareinc.com.

Member Rights Click here for more information

We are committed to supporting your rights. Among other rights this includes your right to availability of services. Assurance that we have adequate provider capacity and services as a DCO. We coordinate your care as applicable. We want you to understand your coverage and our authorization of services requirements.

Also please know OHP members have the availability of an ombudsman (someone to advocate for you).  

As an Oregon Health Plan (OHP) member, you have the right to…

  • Be treated with dignity and respect.
  • Be treated by dentists the same way as other people seeking healthcare.
  • Choose your dentist or where you would like to get care. You can also change those choices.
  • Refer yourself directly to behavioral health or family planning services. A referral from a PCP or other dentist is not needed.
  • Have a friend, family member, or other person with you during appointments.
  • Be involved in creating your treatment plan.
  • Get information about your condition, what is covered, and what is not covered. Then you can make good decisions about treatments.
  • Accept or refuse treatments and be told what might happen based on your decision. Court ordered services cannot be refused.
  • Get a referral or second opinion if you need it at no cost to you.
  • Get written materials that tell you your rights, responsibilities, benefits, how to get services. Or what to do in an emergency.
  • Get written materials explained in a way you can understand them.
  • Learn about coordinated care organizations (CCOs) and how to use the healthcare system.
  • Get services that consider your culture and language and are in a place close to where you live. If available, you can also get care in a non-traditional setting.
  • Get care coordination, management. Or community-based care that works well with your culture and language. To help reduce the need for hospital visits. 
  • Get the needed and proper services to diagnose your health condition.
  • Get person-centered care and services that give you choice, independence, and dignity. This care will meet generally accepted standards of practice.
  • Have a steady and stable relationship with a care team that will look after your overall care management.
  • Get help with using the healthcare delivery system. Find out how to get services such as: 
    • Certified or qualified healthcare interpreters.
    • Certified traditional health workers.
    • Community health workers.
    • Peer wellness specialists.
    • Doulas.
    • Personal health navigators.
  • Get covered preventive services.
  • For males and females under 18 years of age to be provided equal access to appropriate facilities and treatment. Consistent with OHA obligations under ORS 417.270.
  • Get urgent and emergency services 24 hours a day, seven days a week without prior authorization.
  • Get a referral to specialty providers for covered coordinated care services when medically needed.
  • Get help with addiction to tobacco, alcohol, and drugs without a referral.
  • Have a clinical record kept that keeps track of conditions, services received, and referrals made.
  • Have access to request, and get a copy of, your clinical record. Your dentist may charge a fee for the copy.
  • Have the right to request your record be amended or corrected.
  • Be able to transfer your dental records from one dentist to another.
  • Be provided a Member Handbook within 14 days of your enrollment.
  • Annually be advised of the right to have a copy of the Member Handbook and how to get it.
  • Given written notice your PCD is terminating participation. Notice given the later of 30 days prior to termination. Or 15 days after receipt of termination.   
  • Be able to disenroll from Family Dental Care, Inc. at least annually.
  • Free to exercise your rights without it affecting the way you are treated by us or our providers. To not be discriminated against for exercising your rights.
  • If available and upon request have member information communicated electronically.
  • For Customer Service staff to be fully informed of our policies providing you and potential members dental care under OHP.
  • Make a statement of your wishes for treatment. It can tell your wishes to accept or refuse medical, surgical, or behavioral health treatment. It can give instructions and powers of attorney for your healthcare.
  • Get written notices of a denial or change in benefits before they are made.  You might not get a notice if it is not required by federal or state regulations.
  • Make a complaint or file an appeal with Family Dental Care, Inc.
  • Ask for a hearing if you disagree with a decision made by Family Dental Care, Inc.
  • Get certified or qualified healthcare interpreter services.
  • Get notice of an appointment cancellation in a timely manner.
  • Not make caring for you easier for your dentists by doing any of the following:
    • Hold you down.
    • Keep you away from others.
    • Make you do something you don’t want to do.
    • Punish you for something you said or did.
  • Report abuses to Family Dental Care, Inc. and/or the OHP.
  • Get free help from the OHA ombudsperson.

Additional Information on Your Rights as an Oregon Health Plan Member

Learn more about Your Rights (Click ‘Your Rights’ for more information)

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.

Member Responsibilities Click here for more information

As an OHP member, you agree to…
• Choose (or help choose) a Primary Care Dentist (PCD).
• Treat the DCO staff, providers, and clinic staff with respect.
• Be on time for appointments.
• Call in advance to cancel if you are unable to keep appointments.
• Call in advance if you expect to be late.
• Tell your dentist what health insurance you have before your appointment.
• Tell the staff if you were hurt in an accident.
• Be honest with your dentists to get the best service.
• Have yearly dental check-ups and preventive dental services to keep you healthy.
• Get a referral from your PCD to see a specialist if you need it.
• Use your PCD or clinic for all your dental needs except in an emergency.
• Use urgent and emergency care appropriately.
• Let your PCD or PCP know, within 72 hours, if you have used any emergency services.
• Give accurate information to your dentists.
• Help your provider get your health records. This may include signing an authorization to release
your health record.
• Participate in your own healthcare.
• Ask questions if you are unclear about conditions, treatments and other issues related to your
care.
• Tell dentists about all your health issues.
• Use information from your DCO, CCO, dentists, or care teams to make smart decisions about
treatments.
• Help your dentist in the creation of your treatment plan.
• Follow directions from your dentist or ask for another choice.
• Always bring your medical ID cards to appointments.
Tell OHP if:
o You change your address.
o You change your phone number.
o You become pregnant or have a
child.
o Any family member moves out of
the household.
o You get or lose other health
insurance.
o You are injured by another
person, entity, or have a claim for
personal injury.
o You get or lose Medicare
coverage.
o Pay for not covered services.
o Bring issues, complaints, or
grievances to our attention.
o Read all letters from OHA and
Family Dental Care, Inc. sends
you. If you, are you having
problems reading the
information? Call Family Dental
Care, Inc. or OHP Client
Services and ask for help.
o Report Medicaid fraud. Call,
email, or write us if you think you
see fraud. An example would be
charging for a service you didn’t
get. Or if someone is using
another person’s ID to get OHP
benefits.

File a Complaint, Appeal or Grievance Click here for more information
FDCi Member Complaints

HOW TO MAKE A COMPLAINT OR GRIEVANCE  

Are you unhappy with Family Dental Care, Inc., your care or provider? You can complain or file a grievance at any time. We will try to make things better. Call Customer Service toll free at (888) 350-0996 (TTY) 711.  

OHP Complaint Form – English

OHP Complaint Form – Spanish

OHP Complaint Form – Vietnamese

OHP Complaint Form – Russian

You can send us a fax at (503) 644-6488.  Or a letter, our mailing address is:  

Family Dental Care, Inc. 

6700 SW 105th Ave. 

Suite 210 

Beaverton, OR 97008 

Family Dental Care, Inc. will work to resolve your complaint or grievance within five business days. Sometimes we need more than five days.  Then we will send you a letter to let you know why. You will receive a final answer within 30 calendar days. We will not tell anyone about your complaint unless you ask us to. 

Appeals and Hearings. At times we will deny, stop or reduce a medical service your provider has ordered. In that case we will explain why we made that decision. The explanation will come by mail in a Notice of Action letter. You have a right to ask to change it through an appeal and a state fair hearing. You must ask for an appeal.  It must be requested no more than 60 days from the date on the Notice of Action letter. 

APPEALS AND HEARINGS 

If we deny, stop or reduce a service your provider has requested we will mail you a denial letter. The letter will be saying Notice of Adverse Benefit Determination near the top of the page. It will explain why we made that decision. You have a right to ask for the decision to be changed.  This can be done through an appeal and a state fair hearing. You must ask FDCi for an appeal. It can be no more than 60 days from the date on the denial letter. 

HOW TO APPEAL A DECISION 

In an appeal Family Dental Care, Inc. will look at your case again. We may receive additional information. A different dental professional at Family Dental Care, Inc. will review the documentation. This may change the decision. Ask us for an appeal by: 

  • Calling Customer Service toll free at (888) 350-0996 (TTY) 711 
  • Writing us a letter 
  • Filling out an Appeal and Hearing Request, OHP form OHP 3302 or MSC 443. 

OHP Appeal & Hearing Request Form – English

OHP Appeal & Hearing Request Form – Spanish

OHP Appeal & Hearing Request Form – Vietnamese

OHP Appeal & Hearing Request Form – Russian

Do you want help filing an appeal?  Call and we can fill out an appeal form for you to sign. You can ask someone like a friend or case manager to help you. You may also call the Public Benefits Hotline at 800-520-5292.  They provide legal advice and help.  

You will get a Notice of Appeal Resolution from us in 16 days.  This will let you know if the reviewer agrees or disagrees with our decision. Occasionally we need more time to do a good review. Then we will send you a letter saying why we need up to 14 more days. 

You can keep on getting a service that already started before our decision to stop it. You must ask us to continue the service.  This must be within 10 days of getting the denial letter that stopped it. If you continue the service two things can happen. 

  • The reviewer changes the original decision.  The service is approved and OHP will pay for the service. 
  • The reviewer agrees with the original denial.  The services are still denied.  You may have to pay the cost of the services that you received.  This will be for services after the Effective Date on the denial letter. 

PROVIDER APPEALS 

Your provider has a right to appeal for you. This can happen when their dentist’s orders are denied by a plan. You must agree to this in writing. 

HOW TO GET AN ADMINISTRATIVE HEARING 

After an appeal you will receive a Notice of Appeal Resolution (NOAR).  It will tell you if your appeal was upheld or overturned.  Was your appeal for services denied?  Then you can ask for a state fair hearing with an Oregon Administrative Law Judge. You will have 120 days from the date on your NOAR to ask the state for a hearing. Your NOAR letter will have a form that you can send in. You can also ask us to send you an Appeal and Hearing Request form. Call OHP Client Services at 800-273-0557, TTY 711, and ask for form OHP 3302 or MSC 443. 

Completed administrative hearing requests may be:

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

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

At the hearing, you can tell the judge why you do not agree with our decision. Also, why you think the services should be covered. A lawyer is not required, but you can get someone else to help you. This person can be a lawyer or a dental professional.  The member must provide written consent. ​ If you hire a lawyer, you must pay their fees. You can ask for help from the Public Benefits Hotline . It is a program of Legal Aid Services of Oregon and the Oregon Law Center.  Contact them at 800-520-5292, TTY 711. They can give advice and possible representation. Information on free Legal Aid can also be found at oregonlawhelp.org. 

A hearing can take more than 30 days to prepare. You can keep on getting a service that already started before our original denial until then. You must ask the state to continue the service.  It must be within 10 days of getting our NOAR that confirmed our denial.  

  • If you continue the service and the judge agrees with the denial the services are still denied.  You may have to pay the cost of the services that you received. This will be for services after the date on the NOAR. 

EXPEDITED APPEAL OR HEARING REQUEST FOR URGENT PROBLEMS 

Do you and your PCD feel you have an urgent problem?  One that cannot wait for a regular appeal.  Tell us. You can ask for an expedited (fast) appeal. We suggest you have your PCD explain to us its urgency.  You can include a statement from your PCD. You or your PCD can call or email us. If we agree that it is urgent, the appeal will be expedited.  We will call you with a decision within 72 hours. For the quickest results, you can fax your appeal form to (503) 644-6488. Or you can send it by mail: Family Dental Care, Inc. 6700 SW 105th Ave., Beaverton, OR 97008.  

Also, you may request an expedited (fast) hearing from OHA. Fax your hearing request form to: OHP Hearings Unit at 503-945-6035. Include a statement form (form OHP 3302 or MSC 443) from your provider explaining why it is urgent. If OHP agrees that it is urgent, the Hearings Unit will call you in three workdays. 

IMPORTANT TO KNOW: Family Dental Care, Inc. will not affect continuation of service while you appeal a decision. However, you may have to pay for services delivered during the appeal process.  This is if the decision to deny or limit the service is upheld. 

Fraud, Waste & Abuse Click here for more information
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

Clinical Practice Protocols Click here for more information
The following clinical practice guidelines have been reviewed and approved for implementation by the Quality Improvement Committee:

1. Guidelines from the American Heart Association, Prevention of Infective Endocarditis, https://www.ahajournals.org/doi/full/10.1161/circulationaha.106.183095

2. Prevention of Orthopedic Implant Infection in Patients Undergoing Dental Procedures: Evidence-Based Guideline and Evidence Report, https://www.ncbi.nlm.nih.gov/pubmed/23457068

3. Dental Treatment of Patients with Joints Replacement: A Position Paper from the American Academy of Oral Medicine, https://jada.ada.org/article/S0002-8177(14)64743-7/fulltext

4. Dental Radiographic Examinations: ‘Recommendations for Patient Selection and limiting Radiation Exposure’, American Dental Association & Food and Drug Administration, https://www.ada.org/~/media/ADA/Member%20Center/FIles/Dental_Radiographic_Examinations_2012.ashx

5. Oral Health During Pregnancy: ‘A National Consensus Statement’, National Maternal and Child Oral Health Resource Center, https://www.mchoralhealth.org/materials/consensus_statement.php

6. American Dental Association, Center for Evidence-Based Dentistry, ‘Clinical Practice Guidelines’, https://ebd.ada.org/en/evidence/guidelines

7. Academy of Pediatric Dentistry, ‘Oral Health Policies & Recommendations’ (Reference Manual), https://www.aapd.org/research/oral-health-policies–recommendations/

8. Centers for Disease Control and Prevention, Tobacco Cessation, Best Practices, https://www.cdc.gov/tobacco/quit_smoking/cessation/index.htm

9. Oregon Health Authority, October 2018, ‘Oregon Acute Opiate Prescribing Guidelines’, https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SUBSTANCEUSE/OPIOIDS/Documents/Acute-Prescribing-Guidelines.pdf https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SUBSTANCEUSE/OPIOIDS/Documents/oregon-recommended-opioid-guidelines-dentists.pdf

Notice of Non-Discrimination Click here for more information
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.

Family Dental Care, Inc. provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters
• Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as: qualified interpreters and information written in other languages.

If you need these services, please contact FDCi Customer Service at 503.644.2663 TTY 711.

If you believe that Family Dental Care, Inc. has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

(A) Quality Improvement Department
Family Dental Care, Inc.
6700 SW 105th Avenue Suite 210
Beaverton, Oregon 97008
(P) 503.644.2663 TTY 711

You can file a grievance in person or by mail, fax, or our secure web form. FDCi does not accept any personal member information received through unsecure or unencrypted service. If you need help filing a grievance, an FDCi Care Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue,
Room 509F, HHH Building,
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html

English

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (503-644-2663) TTY (711).

Family Dental Care, Inc. (FDCi) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Español (Spanish)

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al Call (503-644-2663) TTY (711).

Family Dental Care, Inc. (FDCi) cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

Russian

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните Call (503-644-2663) TTY (711).

Family Dental Care, Inc. (FDCi) соблюдает применимое федеральное законодательство в области гражданских прав и не допускает дискриминации по признакам расы, цвета кожи, национальной

принадлежности, возраста, инвалидности или пола.

Vietnamese

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số Call (503-644-2663) TTY (711).

Family Dental Care, Inc. (FDCi) tuân thủ luật dân quyền hiện hành của Liên bang và không phân biệt đối xử dựa rên chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính.

Notice of Privacy Practices Click here for more information

NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed. This notice explains how you can get access to this information. Please review it carefully.

PROTECTED HEALTH INFORMATION (PHI)

What is PHI? Protected Health Information, or PHI, is any information that is specific to you and your health, such as:

  • Your Medical History
  • Your Medications
  • Your Test Results
  • Your Social Security Number
  • Your Address or Phone Number
  • Your Date of Birth

Here at Family Dental Care, Inc. we have systems to keep your PHI safe. Our employees get training every year on what needs to be protected, and how.

SHARING YOUR PHI

There are times when we can use and share your PHI. Some examples are:

  • Managing your treatment needs
  • To help your providers
  • Research for our members’ benefit
  • Responding to lawsuits
  • Responding to government requests
  • To help with public safety issues
  • To obey the law


YOUR RIGHTS WITH PHI

You have rights to your PHI. The government says we must give you the chance to:

  • Get a copy of this notice
  • Get a copy of your PHI
  • Get a list of people who have seen your PHI
  • Correct your PHI if it’s wrong
  • Ask us to limit who can see your PHI
  • File a complaint if you think your rights have been violated
  • Choose some to act for you

If you have any questions about this notice, please call Customer Service at the number above.

Read on for more information.

SHARING YOU PHI

We may use or share PHI to do business activities. These activities include things like:

For TreatmentReferrals and Prior-Authorizations.
Case Management or Care Coordination.
Programs for early detection of disease.
Health Care OperationsTo give you more information about new treatments or benefit options.
To help perform business with other companies, like paying your provider.
To help public health authorities to prevent public health and safety issues.
With law enforcement when required by law.
With research companies when approved by the appropriate governing bodies.

We will protect your PHI and make sure that all sharing of this information follows the rules above. If we use or share your information for any other reason not allowable by law, we will get your written permission.

YOU HAVE THE RIGHT TO

Get a copy of your PHI.You must ask for this in writing. Send a letter to the address above. You will get a response within 30 days.
Correct your PHI if it is wrong.You must ask for this in writing. We cannot change some of your information. If we cannot make the changes you asked for, we will let you know.
Get a list of people who have seen your PHI.You must ask for this in writing. It may not include some who have seen your PHI for purposes like providers or law enforcement.
Restrict or limit us from using your PHI.You must ask for this in writing. If there are certain people or companies, you do not want us to share your PHI with please tell us.
Share your PHI with someone.You must ask for this in writing. If you would like someone you know to help you with your health management please tell us. We just need to know who it is, and for how long you want them to have access. Remember that once we get permission to share information, we cannot be certain that the person who gets the information from us will not share it with someone else.
Choose your method of communication.If you would like us to send you information in a certain way, please tell us. This could be anything from using the right phone number or email, to asking us not to send any letters through the US mail. Only if required by law, we may not be able to agree with your request.
Get a copy of this notice.At any time, you can ask us for a copy of this notice. This can be done by phone, email or US mail.

FILING A COMPLAINT

If you think your privacy has been shared when it should not have been, you may send a written complaint to our Appeals & Grievances Department. We will not react against you for your complaint.

Please send your complaint to:
    Family Dental Care, Inc.
    Attn: Appeals and Grievances Department
    6700 SW 105th Ave., Suite 210
    Beaverton, OR 97008

You may also send your complaints to the US Department of Health and Human Services:
    U.S. Department of Health and Human Services
    200 Independence Ave. SW
    Room 509F, HHH Building
    Washington DC 20201

CHANGES TO THIS NOTICE

We can change the terms of this notice, and the changes will apply to all information we have about you. Updated notices will be available in our office and on our web site: familydentalcareinc.com.

For more information on this notice of privacy practices:

Contact the Family Dental Care, Inc. (FDCi) Compliance Officer at 503-644-2663 or toll-free at 888-350-0996, TTY 711, if you have any questions about this notice or if you want more information on privacy.

Privacy rules are overseen by the Compliance Officer, who also acts as the Privacy Officer.

This notice is effective January 2, 2020.

Cancellations, Missed Appointments & No Shows Click here for more information

FDCi takes cancellations, missed appointments and no shows seriously. These are missed opportunities for dental care, and actions may be taken when a member misses 2 or more appointments. Remember to notify your dentist more than 24 hours before your appointment if you will not be able to make it. This allows dentists the time to cancel your appointment reasonably and perhaps offer the time to someone else. Sometimes things come up and we understand. The important thing is to communicate with your dental office if you can’t make it in.

Sometimes our dentists have something come up like an emergency appointment. Our clinics will also do their best in notifying members as soon as possible if there is going to be a wait for them to be seen. If the wait is longer than 45 minutes, the clinic staff will offer the member the opportunity to reschedule.

**If a Member has two or more late canceled or missed appointments this may lead to more serious actions being taken by the provider such as dismissing the patient. When a Member has missed two appointments or been dismissed for this reason FDCi will advise the Member through a letter of the seriousness of missing or late-cancelling multiple appointments and indicate that further late-cancelled or missed appointment may result in FDCi contacting the state to determine actions that may be taken.  A member who has been dismissed will be assisted by FDCi in finding a new Primary Care Dentist (PCD).

Transitions of Care

This policy establishes standards for transitions of care for Family Dental Care, Inc. (FDCi) members. We are committed to helping our members in transitions of care from one provider to another, and/or one payer/plan (DCO) to another.

Definitions

Transitions of Care: The hand-over of responsibility from one provider to another, and/or one payer/plan (DCO) to another.

Hand-over: Transfer of information and responsibility from one provider to another and/or one payer/plan to another.

HIPPA: Health Insurance Portability and Accountability Act, a 1996 federal law that restricts access to an individual’s personal health information (PHI).

Procedures:

All FDCi staff are encouraged to assist a member, member representative, caretaker, family member, members of the care team, providers, payers, plans and others as applicable to ensure a smooth transition of a member’s care.

To request transition of care assistance from FDCi the member, member representative, caretaker, family member should contact Customer Service at 888-350-0996 TTY 711 to request help.

On the call Customer Service will gather information including a health risk screening relevant to the transition. Obtain any approvals needed under HIPAA for sharing PHI and identifying restrictions/ limitations the member wishes to exercise.

A provider, members of the care team, payers, plans and others as applicable may contact FDCi to request transition of care assistance on behalf of the member.

Following receiving such a request, FDCi will contact the member.

On the call Customer Service will gather information including a health risk screening relevant to the transition. Obtain any approvals needed under HIPAA for sharing PHI and identifying restrictions/ limitations the member wishes to exercise.

During a health risk screening, health risk assessment, and/or other means should FDCi become aware of a member who will be transitioning from care possibly needing our assistance Customer Service will call the member.

On the call if the member wants assistance Customer Service will gather information relevant to the transition. Obtain any approvals needed under HIPAA for sharing PHI and identifying restrictions/ limitations the member wishes to exercise.

Should a call to the member not find the member at home a letter will be sent for him/her to contact Customer Service. A Member note will be placed by Customer Service of the letter being sent.

Customer service will add members requesting transition of care assistance and/or receiving a call or letter to the care coordination log.

A file will be opened when the member requests transition of care assistance. 

Regardless of how the request for transition of care assistance is identified, Customer service will assist the member by providing him/her with administrative information (i.e. prior authorizations, referrals, claims history, provider history etc.) relevant to the transition.

Should the member request hard copies Customer Service will provide at no cost to the member.   

Customer Service will share copies of administrative information related to the transition to the provider, plan, payer that the member is transitioning.

Customer service will advise the member on how to obtain clinical records from one treating provider for transfer to another treating provider.

Should the member request assistance obtaining clinical records and/or have difficulties obtaining them Customer Service will help the member.

Based on the member’s information shared Customer Service will help with the transfer of information to other providers, plans, payers as applicable with the member’s permission.

FDCi supports and follows these guiding principles related to transitions of care:

  • Staff will support a member changing providers and/or plans to be able to get the same services and see the same providers.
  • Staff will help a member obtain administrative and/or clinical dental records applicable to the transition of care to facilitate ongoing continuity of care, avoid interruption of services, or a need to duplicate services.
  • Staff will provide the member, member representative, family an opportunity to ask us questions and get answers related to the transition of care.
  • Prior to hand-over of any PHI documents staff will do so in a manner that is HIPAA compliant.

How do I know if I need URGENT Dental Care or EMERGENCY care?

Please read below if you are unsure of what to do when experiencing dental pain.

Urgent care can be handled within 1 to 2 weeks depending on the member’s condition by your FDCi Provider.

Urgent dental care requires prompt but not immediate treatment.

Examples of Urgent Conditions:

  • A toothache
  • Swollen or bleeding gums
  • Crowns that have fallen off or broken
  • Pain that is bad enough to keep you from sleeping or eating and does not stop when you take over the counter medicine such as Aspirin or Tylenol

Before going to an urgent care facility for dental pain you should: contact your primary dentist office, they will evaluate your condition and make an appointment appropriate for your needs.

(Without approval from your dental plan you may be responsible for the cost of your bill.)

Emergency care is covered 24 hours a day, 7 days a week, by your FDCi Provider.

A dental emergency is dental care requiring immediate treatment.

Examples of Dental Emergencies:

  • A tooth that has been knocked out
  • Fracture to the jaw/facial bones
  • Heavy Bleeding that does not stop
  • Infection that makes it hard to breathe or swallow

Before going to an emergency facility for dental pain you should contact your primary care dentist, or their after-hours phone line.

(Without approval from your Dental Plan you may be responsible for the cost of your bill.)