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.
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.
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:
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.
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.