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Member Handbook
Access Dental Plan – October 2014
ALTERNATIVE FORMAT:
If you need our materials in another format, such as other
language, large print, computer disk, Braille, audio tape or
oral presentation, please call our Customer Service
Department at 503-445-9056, 1-877-213-0357 or TTY 7-1-1
to request the format you need. (English)
Si ud. necesita nuestro material en español o en un formato
alternativo, tal como Letra grande, Disco, Braille, Audio
casete, Presentación oral, llame, por favor, al departamento
de información y reclamaciones al 503-445-9056, 1-877213-0357, o para TTY (para sordos) al 7-1-1. (Spanish)
Если вам нужны наши материалы на русском языке или в
другом варианте, например Крупным шрифтом, На
компьютерной дискете, Шрифтом Брайля, На
аудиокассете, pассказать устнопозвоните, пожалуйста, в
наш Отдел бслуживания по тел. 503-445-9056, 1-877-2130357, для плохослышащих 7-1-1. (Russian)
Neu qui vi can nhung tai lieu cua chung toi bang tieng Viet
nam hay bang mot phuong phap thay the khac, chang han
nhu Chu in lon, Bang ghi hinh, Dia cua may dien toan, Trinh
bay qua dam thoai, Chu danh cho nguoi khiem thi, xin qui vi
goi den Van Phong Phuc Vu Khach Hang chung toi o so dien
thoai mien phi 503-445-9056, 1-877-213-0357 hay so dien
thoai danh cho nguoi bi diec 7-1-1. (Vietnamese)
Access Dental Plan – Oct 2014
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ACCESS DENTAL PLAN – ADMINISTRATION ADDRESS:
14201 NE 20th Avenue, Suite 2204
Vancouver, WA 98686
LOCAL PHONE:
TOLL-FREE PHONE:
TTY (HEARING IMPAIRED):
1-503-445-9056
1-877-213-0357
7-1-1
HOURS OF OPERATION: 8:00 A.M – 5:00 P.M – MONDAY – FRIDAY
Access Dental Plan provides INTERPRETER SERVICES for all our
members (language or sign). To help you set up the interpreter services
please call the toll free Member Services Line:
Our website: www.accessdentalplan.net has online Member Handbooks in
other languages.
SEE PAGE 20 FOR A LISTING OF PRIMARY CARE DENTISTS (PCD)
Access Dental Plan – Oct 2014
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CONTENTS
WELCOME TO ACCESS DENTAL PLAN
4
DEFINITIONS / WORDS TO KNOW
5
HOW ACCESS DENTAL PLAN OPERATES
How to Choose a Primary Care Dentist
DMAP Medical Care Identification (ID)
Your Dental Records and Privacy
6
6
7
GETTING DENTAL CARE
Making Appointments
Missed Appointments
Exceptional Needs Care Coordination (ENCC)
Service for Children Under Age 18
Referral Services and Prior-Authorizations
Transportation Services
If You Move
7
7
8
8
8
8
9
EMERGENCIES
Emergency Definition
Urgent Care Definition
Emergency and Urgent Dental Care – Local Area
Emergency and Urgent Dental Care – Out of Town
9
9
10
10
DENTAL BENEFITS AND SERVICES – OREGON HEALTH PLAN
OHP Plus Plan
Services Not Covered under Oregon Health Plan
11-12
13
Complaint Procedures
Plan Appeals and DMAP Administrative Hearings
Changing Dental Plans
Disenrollment Request by Access Dental Plan
Members’ Rights
Members’ Responsibilities
Information Available Upon Request
We are Here to HELP !!!
Primary Care Dentists
13
13-15
15-16
16
17
18
19
19
20
Access Dental Plan – Oct 2014
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WELCOME TO ACCESS DENTAL PLAN
Welcome to ACCESS DENTAL PLAN. We want to give you and your
family the best dental services available under the Oregon Health
Plan (OHP). Like our name suggests, we know that getting care
when you need it is important to you.
We believe that our staff and our contracted dentists have a good
understanding of the Oregon Health Plan. This understanding,
combined with your efforts to maintain and improve your oral health,
will result in you and your family having the best dental health
possible.
It is important to us that all of our members understand their dental
plan. This handbook provides you with the running start to ACCESS
your dental benefit.
Did you know?
The Oregon Health Plan (OHP) was created in 1994 as a first ever
statewide expanded Medicaid system.
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DEFINITIONS / WORDS TO KNOW
“Member” – Any person enrolled in Access Dental Plan.
“Primary Care Dentist (PCD)” - A Dental Practitioner who is responsible for
supervising and managing dental care for Access Dental Plan members.
Primary Care Dentists initiate referrals for care outside of their practice.
“Service” - Any dental procedure or item provided by a dentist.
“Non-covered service” - Services for which Access Dental Plan is not
responsible for payment.
“Prior-Authorization” - Services that Access Dental Plan must review and
approve before your dentist can perform the service.
“Referral” – Services that Access Dental Plan must review and approve before
you are sent to another dentist, such as a specialist.
“Action” by Access Dental Plan
 The denial or limited authorization of a service, including the type or level
of service
 The reduction, suspension or termination of a previously authorized
service;
“Notice of Action” - A letter sent by Access Dental Plan to the member notifying
the member of an “Action” by Access Dental Plan.
“Appeal” - If a member receives a “Notice of Action”, the member can request
an appeal and review of the “Action” by Access Dental Plan’s Dental Director.
“Grievance System” - The overall system that includes member complaints and
“Appeals”.
“Emergency” and “Emergency Services” - See pages 9-10
“Urgent Care”- See page 9-10
“Post Stabilization Care Services”- Services related to an emergency that are
provided after a member is stabilized to maintain the stabilized condition, or to
improve or resolve the member’s condition.
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HOW ACCESS DENTAL PLAN OPERATES
HOW TO CHOOSE A PRIMARY CARE DENTIST (PCD):
We will try to call you and offer you a selection of Primary Care Dentist (PCD)
that best fits with your location and schedule.
You may also choose a Primary Care Dentist (PCD) from the list on page 20.
You may choose the same dentist for all members of your family covered on the
OHP, or you may choose different PCD’s. If you do not choose a PCD, one will
be assigned for you. After choosing your PCD, you will become their regular
patient. After your first visit your dentist will continue to see you for routine dental
care. Be sure to call your PCD first for all dental care needs.
After your enrollment in Access Dental Plan, if you cannot find services from a
PCD in the first month, please call us at 1-877-213-0357 or TTY (hearing
impaired) 7-1-1 and we will help arrange your appointment with a PCD.
DMAP MEDICAL CARE IDENTIFICATION (ID):
The Division of Medical Assistance Programs (DMAP) provides you with a Medical
Care Identification (ID) card only once at the time of enrollment. It will show you
your name and date enrolled. Everyone who is eligible in your household will
receive their own Medical Care ID. You must bring your DMAP Medical Care
Identification with you to every dental appointment. In addition to your new
Medical Care ID card, you will receive a Coverage Letter. It will show you your
Case Worker’s ID and phone number, your benefit package, and managed care
enrollment. The Coverage Letter will list coverage for everyone in your household
who gets a Medical Care ID card. You will receive a new Coverage Letter only if
you ask for one or if the information on the letter changes. You do not need to
bring the Coverage Letter to appointments.
COORDINATE CARE ORGANIZATION - IDENTIFICATION (ID):
You will also receive a Coordinated Care Organization (CCO) ID card with
contact and emergency information.
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YOUR DENTAL RECORDS AND PRIVACY:
Your records are kept private by your Access Dental Plan PCD and specialists.
Access Dental Plan and its contracted dentists follow the rules set forth in the
Health Insurance Portability and Accountability Act (HIPAA). Information in your
records will not be released without your permission, except as needed by
DHS/DMAP.
You can request copies of your dental records. You can also request that your
dental records are corrected if you see an error. Access Dental Plan will not
charge you for copying your dental records or for transferring them to another
dental office.
GETTING DENTAL CARE
MAKING APPOINTMENTS:
To make an appointment with a Primary Care Dentist (PCD) please choose a PCD
in your area from the locations listed on page 20.
When making an appointment, please give clear information about your dental
needs and why you need to see the dentist. For example:
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Routine dental care;
Preventing problems;
Follow up appointments;
Urgent and emergency dental care.
You should make appointments for all of your family members who are covered by
OHP.
Please call Access Dental Plan at 1-877-213-0357 or TTY (hearing impaired)
7-1-1 if you are unable to get services in the first month following enrollment.
MISSED APPOINTMENTS:
Access Dental Plan understands that sometimes you may not be able to keep your
dental appointments. If you are unable to go to your dental appointment, please
make sure that you call the office (listed on page 20 of this Member
Handbook) and cancel your appointment 24 hours in advance. When you do not
cancel your dental appointment we are unable to offer that time to another member.
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EXCEPTIONAL NEEDS CARE COORDINATOR (ENCC):
Exceptional Needs Care Coordinator (ENCC) helps members who are aged,
blind, disabled or with special health care needs (like special equipment or
supplies). ENCC services help members who have a special needs get additional
help with their dental care. If you need help for any of these reasons, please call
1-877-213-0357 or TTY (hearing impaired) 7-1-1.
SERVICES FOR CHILDREN UNDER AGE 18
If your child is under the age of 18 an adult must go with them to the dentist.
PRIOR AUTHORIZATION SERVICES:
Some services require prior authorization from Access Dental Plan before they
are performed by your PCD. They are: hospital dental services, molar root
canals, dentures, crowns, retreatment of anterior root canals, and wisdom tooth
extractions. See PLAN APPEALS AND DMAP ADMINISTRATIVE HEARINGS on pages
13-15.
REFERRAL SERVICES:
Access Dental Plan PCD’s provide most dental services, although there are some
services that we do not offer to our patients. When your Primary Care Dentist
(PCD) thinks you need those services, you will be referred to another dentist.
Referrals are made on a case-by-case basis when your dentist feels it is necessary.
When your PCD decides to refer to another dentist, he/she will contact Access
Dental Plan for approval. Access Dental Plan must approve the referral before you
go to your appointment. If the referral is approved, Access Dental Plan will contact
you with the dentist’s name, address, and phone number. You will be asked to
make an appointment with the dentist and take the referral form with you to the
appointment.
IMPORTANT TO NOTE:
GOING TO A SPECIALIST WITHOUT A REFERRAL FROM YOUR PCD COULD RESULT IN
YOUR BILL NOT BEING PAID. THIS MAY MEAN YOU WOULD HAVE TO PAY THE BILL.
TRANSPORTATION SERVICES:
If you need help in getting to the dentist, call your Coordinated Care Organization
(CCO) or Access Dental Plan at 1-877-213-0357 or TTY (hearing impaired)
7-1-1 for help with transportation.
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IF YOU MOVE:
If you move please do the following:
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Tell your CCO of your move and address change.
Tell Access Dental Plan at 1-877-213-0357 or TTY (hearing
impaired) 7-1-1.
DENTAL EMERGENCIES AND URGENT CARE
EMERGENCY DEFINITION:
Emergency dental care is available 24 hours a day, 7 days a week. An
emergency is a serious problem that needs immediate care. It could be an injury
or sudden severe condition. Some examples of emergency situations are:
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Bad infection;
Bad abscesses (blister on gum tissue);
Severe tooth pain (pain that does not stop when you take over-the-counter
pain killers);
A tooth knocked out;
If your emergency is life threatening, dial 911 for Emergency Medical
Services or go immediately to a hospital emergency room.
URGENT CARE DEFINITION:
“Urgent” dental care is dental care that needs prompt but not immediate
treatment. Some examples of urgent situations are:
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A toothache;
Swollen gums;
A lost filling;
Always contact your PCD prior to going to an urgent care center or an
emergency room. The PCD will be able to help you make the right choice for
your dental condition. An urgent care center or emergency room is only for a
VERY BAD PROBLEM.
Some dental services require Access Dental Plan’s approval before they can be
performed. These are called prior-authorizations. Emergency or urgent services
will not require a prior-authorization that will delay treatment.
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EMERGENCY AND URGENT DENTAL CARE – LOCAL AREA:
Normal Business Hours:
Patients who have a regular dentist – If you have already seen an Access Dental
Plan dentist (your PCD), call the phone number for your PCD (listed on page 20
of this Member Handbook).
Patients who have not visited an Access Dental Plan PCD – Call the phone
number for the closest PCD to you (listed on page 20 of this Member Handbook).
After Hours: Same phone instructions as Normal Business Hours.
You will be connected with the answering service operators who will take your
message and forward it to the on-call dentist. The on-call dentist will call you
back. If the dentist thinks that hospital emergency room care is necessary, you
will be told to go to the hospital or an urgent care center.
EMERGENCY AND URGENT DENTAL CARE – OUT OF TOWN:
If you are traveling outside Access Dental Plan’s service area and have an
emergency, first try to contact your PCD (same phone instructions as listed
above). If you receive emergency dental care out of the area have the dentist
send us an itemized billing, and chart notes showing a dental emergency.
After you see a dentist for a true emergency, please call your PCD to arrange for
further care if it is needed while you are gone. Also, call for follow-up or transfer
of your care when you return. All the services they perform to stabilize your
condition will be covered by Access Dental Plan.
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DENTAL BENEFITS AND SERVICES–OREGON HEALTH
PLAN
Please refer to your Coverage Letter that you receive from DMAP, or call
1-877-213-0357 TTY (hearing impaired) 7-1-1 to determine your specific
coverage package.
OHP PLUS PLAN
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 a full range of dental services,
including preventive care, emergency, and restorative care.
Non-pregnant women and members 21 years and older:
These OHP Plus members are covered for preventive care, emergency and
some restorative care (less restorative care).
Under OHP coverage guidelines, dental services may not be approved
when the treatment probably will not make the outcome better. How well
you take care of your teeth at home will help decide which services you will
get.
Preventive Care (OHP Plus Plan)
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
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For children (under 19 years of age), twice in any 12-month period
For members 19 and older, once in any 12 month period
 ROUTINE X-RAYS, once in any 12-month period
 FULL MOUTH X-RAYS OR PANORAMIC FILMS, once every five years
 SEALANTS, covered for members under 16 years old, on permanent
molars (back teeth) once every five years
 TOBACCO CESSATION
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Other covered services (OHP Plus Plan)
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
 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 premolars closest to the front of the mouth) for all
members
- For molar teeth (first and second molars) if you are under 21
- For molar teeth (first molar only) if you are pregnant and age 21 or
older
 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
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If you are missing one or more anterior (front) teeth or four or more
posterior (back) teeth for members under age 21
- If you are missing one or more anterior teeth (front) or six or more
posterior (back) teeth for members for members age 21 and older
 PARTIAL DENTURES – REPLACEMENT once every 10 years for all
members
 COMPLETE AND IMMEDIATE DENTURES if you are age 16 or older 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.
 COMPLETE AND IMMEDIATE DENTURES – REPLACEMENT of a denture is
allowed only once if you are between the age of 16 and 20. This
replacement will be covered only if it has been at least 10 years since
you had your complete denture. Replacement of a denture is not
allowed if you are age 21 or older.
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SERVICES NOT COVERED UNDER OHP:
If you choose to have dental services that are not covered under OHP, you must
sign a financial responsibility form that shows you understand that the services
listed are not covered and the amount you have to pay. Payment is required
before those services are completed.
COMPLAINT PROCEDURES
Access Dental Plan wants all of our members to be satisfied with their dental care.
If you have a complaint for any reason, contact your PCD or Access Dental Plan by
phone or in writing. We will look into both dental and non-dental problems. We will
contact you within five (5) working days and will provide you with a decision within
thirty (30) days. All information about your complaint will be kept private.
PLAN APPEALS AND DMAP ADMINISTRATIVE HEARINGS
Appeal Procedures – Access Dental Plan
We have an appeal process available if you are denied a service. If you receive a
“Notice of Action” to deny or limit services, and you disagree with the decision, you
may ask for an appeal from Access Dental Plan. You can appeal either by phone
or in writing within 45 days of the date on the “Notice of Action”: please use the
Access Dental Plan contact information found on page 1 of this Member Handbook.
If you call, you will have to follow up with a written, signed letter of appeal.
Access Dental Plan will review your appeal and give you a decision within 16
calendar days. The notice will be called the “Notice of Appeal Decision”.
If you believe your dental problem cannot wait for an appeal to Access Dental
Plan, you can ask for an expedited appeal. We will determine if your appeal
cannot wait for the regular appeal process, and if so, we will notify you within 3
business days of our decision.
Before the appeal process is finished, you can request a continuation of benefits
pending appeal. This means you can have the services performed before the
appeal process is finished. How it works:
1) The original appeal must be submitted to Access Dental Plan on time;
2) You need to request a continuation of benefits by contacting Access
Dental Plan at 1-877-213-0357 or TTY (hearing impaired) 7-1-1.
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The dental treatment that is on hold due to the appeal process will be performed.
However, if the appeal decision results in a denial of the treatment, Access
Dental Plan can bill you for the services.
IMPORTANT TO NOTE:
YOUR PCD ALSO HAS THE RIGHT TO APPEAL DENIED OR LIMITED SERVICES ON YOUR
BEHALF, IF THEY FEEL THAT ACCESS DENTAL PLAN’S DENIAL OR LIMITATION OF THE
SERVICES IS NOT CORRECT.
If you have questions on the appeal process with Access Dental Plan, please call
1-877-213-0357 or TTY (hearing impaired) 7-1-1 and we will help you.
You may also call the Public Benefits Hotline (a program of Legal Aid Services of
Oregon and the Oregon Law Center) at 1-800-520-5292 or TTY (hearing
impaired) 7-1-1 for advice and possible representation. Information about the
Legal Aid Services of Oregon can also be found at www.oregonlawhelp.org.
Administrative Hearings - DMAP
We ask that you complete our appeal process before you ask for an
Administrative Hearing, but you can ask for both at the same time. If you
want an Administrative Hearing, you must request an Administrative Hearing
within 45 days from the date on the Notice of Action. You will have received an
Administrative Hearing Form (DHS 443) with your Notice of Action Letter giving
you instructions on how to request an Administrative Hearing.
IMPORTANT TO NOTE:
IF YOU FILED AN APPEAL WITH ACCESS DENTAL PLAN AND RECEIVED A “NOTICE OF
APPEAL DECISION” THAT DENIED OR LIMITED THE SERVICES THAT WERE APPEALED,
YOU CAN STILL REQUEST AN ADMINISTRATIVE HEARING WITHIN 45 DAYS FROM THE
DATE ON THE “NOTICE OF ACTION”.
IMPORTANT TO NOTE:
IF YOU ASK FOR AN ADMINISTRATIVE HEARING, YOU MAY HAVE ANOTHER PERSON
SPEAK ON YOUR BEHALF OR HAVE AN ATTORNEY REPRESENT YOU. DMAP CANNOT PAY
FOR THE COSTS OF AN ATTORNEY OR WITNESSES.
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You should submit your Form DHS 443 to Access Dental Plan at the address
listed on page 2 of this Member Handbook. We will forward to DMAP. In
addition to sending us the DHS 443, you can also send a copy of the DHS 443
directly to DMAP:
Division of Medical Assistance Programs
Hearings Unit
500 Summer St. NE, E-49
Salem, OR 97301-1079
If you believe your dental problem cannot wait for an Administrative Hearing, you
can ask for an “Expedited Fair Hearing” with DMAP. The DMAP Medical Director
will review your medical records and decide if your dental problem cannot wait for
the regular hearing process.
Before the Administrative Hearing process is finished, you can request a
continuation of benefits pending Administrative Hearing. This means you can
have the services performed before the Administrative Hearing process is
finished. How it works:
1) The request for an Administrative Hearing must be submitted on time;
2) You need to request a continuation of benefits by contacting Access
Dental Plan at 1-877-213-0357 TTY (hearing impaired) 7-1-1.
The dental treatment that is on hold due to the Administrative Hearing will be
performed. However, if the appeal decision results in a denial of the treatment,
Access Dental Plan can bill you for the services.
If you have questions on the Administrative Hearing process with DMAP, please
call 1-877-213-0357 or TTY (hearing impaired) 7-1-1 and we will help you.
CHANGING DENTAL PLANS
You may change your dental plan:
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If you did not select a dental plan and one was assigned to you. Contact
your CCO within 30 days from receiving your Medical Care ID Card and
Coverage Letter.
When you reapply for coverage;
If you move out of Access Dental Plan’s coverage area, or away from your
PCD;
For any important reason that DMAP approves;
Access Dental Plan – Oct 2014
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To change your plan, contact your CCO. Ask when your change will go into
effect. If you need dental care before the change goes into effect, call us and we
can help you get the care you need.
DISENROLLMENT REQUEST BY ACCESS DENTAL PLAN
Access Dental Plan can ask DMAP to disenroll you from our plan for the
following reasons:
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Member’s behavior is disruptive, unruly, or abusive to the point that his/her
enrollment seriously hurts the PCD's ability to provide services to either
the Member or other members;
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Member becomes violent or threatens to hurt a PCD or property, the
PCD's staff, or other patients, or Access Dental Plan’s staff;
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Member commits fraud or illegal acts such as: allowing others to use
his/her medical ID card, altering a prescription, theft or other criminal acts
committed in any Provider or PCD’s location;
Before we request that DMAP disenrolls you from Access Dental Plan, we will
attempt to contact you and understand your point of view. Based on our
communication with you, we hope that the problem will not continue. If the
problem does continue, we can request that you are disenrolled from Access
Dental Plan.
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MEMBERS’ RIGHTS
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To be treated with dignity and respect.
To be treated by participating providers the same as other people
seeking health care.
Right to choose a PCD
Refer oneself directly to mental health, chemical dependency or
family planning services without a referral from your PCD.
To have a friend, family member, or advocate present during
appointments.
To be actively involved in the development of your treatment plan.
To be given information about your condition and covered and noncovered services to make an informed decision on treatment.
To consent to treatment or refuse services and know the
consequences.
To receive written material describing rights, responsibilities, benefits
available, how to access services, and what to do in an emergency.
To receive necessary and reasonable services to diagnose the
condition.
To receive covered services under the Oregon Health Plan.
To have written materials explained to you in a manner that is
understandable. Access to Emergency and Urgent services 24 hours
a day, 7 days a week.
Be referred to specialty care providers.
Have a clinical record maintained which documents conditions,
services received, and referrals made.
To have access to your own clinical record.
To transfer a copy of your own clinical record to another provider.
To execute a statement of wishes for treatment and obtain a power of
attorney or advance directives including the right to accept or refuse
treatment.
Receive written notice before a denial of, or change in, a benefit or
service level is made, unless such notice is not required by federal or
state regulations.
To know how to make a complaint, grievance, or appeal and receive
a response.
To receive interpreter services.
Request an Administrative Hearing with the Department of Human
Services (DHS).
Receive a notice of an appointment cancellation in a timely manner.
To obtain covered preventive care.
To pay for non-covered services.
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MEMBERS’ RESPONSIBILITIES
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To choose a PCD.
To treat the Access Dental Plan staff, PCD’s, and clinical staff with
respect.
Be on time for appointments made with providers and to call in
advance to cancel if unable to keep the appointment.
To seek periodic health exams and preventive services from your
PCD or clinic.
To use your PCD or clinic for diagnostic and other care except in an
emergency.
To obtain a referral to a specialist from the PCD or clinic before
seeking care from a specialist unless self-referral to the specialist is
allowed.
To use Urgent and Emergency Services appropriately and notify
your PCD within 72 hours of an emergency.
To help in the creation of a treatment plan.
Follow prescribed agreed upon treatment plans.
To tell your CCO if any family members move in or out of the
household.
To pay the monthly OHP premium on time if so required.
To give accurate information to be included in your clinical record.
To sign an authorization for release of medical information so DHS
and Access Dental Plan can get information, which is pertinent and
needed to respond to an Administrative Hearing.
To help the provider or clinics obtain clinical records from other
providers, which may include signing an authorization for release of
information.
To ask questions about conditions and other treatment that is not
understood.
To use information to make informed decisions about treatment
before it is given.
To tell your CCO and Access Dental Plan of a change of address or
phone number.
To bring issues, complaints or grievances to the attention of Access
Dental Plan.
To tell your CCO if the Access Dental Plan member becomes
pregnant and to notify the CCO of the birth of the Access Dental
Plan member’s child.
Show provider your Medical ID Card.
To tell your CCO if there is any other insurance available.
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INFORMATION AVAILABLE UPON REQUEST
As a member of Access Dental Plan, you can request the following information:

Information on the structure and operation of Access Dental Plan.

Information on any incentive plans between Access Dental Plan and the
PCDs who have contracts to provide services to Access Dental Plan
members.
WE ARE HERE TO HELP !!!
We welcome you to call our Member Services Line at 1-877-213-0357 or TTY
TTY (hearing impaired) 7-1-1 if you have any questions about your benefits.
We value your membership in Access Dental Plan and we are happy to serve
you.
Access Dental Plan – Oct 2014
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Access Dental Plan ‐ Primary Care Dentists
Dental Care Today ‐ Broadway
3502 NE Broadway
Portland, OR 97232
(503) 284‐1602
Accepting new patients
Caitlin Han, DMD
Mili Patel, DDS
Jovan Gvozden, DMD
Other language(s): Hindi
Dental Care Today ‐ Gateway
10535 NE Glisan Street, Suite 301
Portland, OR 97220
(503) 444‐2824
General Dentistry
General Dentistry
General Dentistry
Dental Care Today ‐ Hillsboro
2251 SE TV Highway
Hillsboro, OR 97123
(503) 846‐1989
Accepting new patients
James Bell, DMD
General Dentistry
Amanda Hawes, DMD
General Dentistry
Karie Lee, DMD
General Dentistry
Jovan Gvozden, DMD
General Dentistry
Banu Ramkrishna, DMD
General Dentistry
Katie Harper, DMD
Pediatric Dentistry
Other language(s): Spanish, Vietnamese, Korean
Dental Care Today ‐ Beaverton
13831 NW Cornell Road, Suite C
Portland, OR 97229
(503) 718‐3762
Accepting new patients
Mili Patel, DDS
General Dentistry
Denise Gates, DMD
General Dentistry
Other language(s): Spanish, Hindi
Accepting new patients
Melissa Colasurdo, DMD
General Dentistry
Jeremiah Leary, DMD
General Dentistry
Karley Bedord, DMD
General Dentistry
Jovan Gvozden, DMD
General Dentistry
Kevin Ford, DMD
General Dentistry
Adam Egge, DMD
General Dentistry
Susanny Thenus, DMD
General Dentistry
Natasha Bramley, DMD
Pediatric Dentistry
Katie Harper, DMD
Pediatric Dentistry
Other language(s): Spanish, Arabic, Russian, Romanian
Laotian, Hindi
Gentech Dentist ‐ Clackamas
13023 SE 84th Avenue, Suite A
Clackamas, OR 97015
(503) 353‐9992
Accepting new patients
Darius Arlauskas, DMD
General Dentistry
Jovan Gvozden, DMD
General Dentistry
Susanny Thenus, DMD
General Dentistry
Casey Nelson, DMD
Pediatric Dentistry
Other language(s): Spanish, Farsi, Arabic, Russian
Romanian
Family Dentistry
128 Ross St
Molalla, OR 97038
(503) 829‐7567
Accepting new patients
Paul Baumgartner, DMD
Daryl Johnson, DMD
Marianna Mclean, DMD
William Melby, DMD
General Dentistry
General Dentistry
General Dentistry
General Dentistry
If you need help choosing a provider, please call Access Dental Plan Member Services at:
(503) 445‐9056 or toll‐free at (877) 213‐0357 ||TTD: 711
*** ALL OFFICES OPEN TO MEMBERS WITH DISABILITIES ***
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