Member Services Guide

Capitol Dental Care
3000 Market Street Plaza NE
Suite 228
Salem, Oregon 97301

(800) 525-6800 or (503) 585-5205
www.capitoldentalcare.com

Welcome to Capitol Dental Care (CDC)!

We are a managed dental care plan, and use dentists who are on our Plan for your dental care.

Appointments  

The dentists on our Plan will care for you at a scheduled appointment time. Once you are ready to make an appointment, please call our member service department, for the name of a primary care dentist (PCD) located in your area. Then call the dentist and ask for an appointment.

If you have been unable to obtain an appointment on your own, call our member service department for help.

Going to a dentist not on our Plan (without approval by CDC) could result in your bill not being paid. This may mean you would have to pay the bill.

Important Appointment Information

Arrive at your appointment on time. Keep all your appointments. If you won’t be able to make it to an appointment, call and cancel at least 24 hours before your appointment time. CDC takes missed appointments very seriously.

Be Sure to Call Your Primary Care Dentist (PCD) First

Be sure to call your primary care dentist (PCD) first for all your dental care needs. The dentist who will be your PCD has a special role in managing your dental care. Sometimes members need more than basic dental care. Your PCD will, if necessary, refer you to a specialist.

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.

Covered Services Under the OHP

What is covered? The OHP covers ‘basic dental care.’ Many services have limits, and others need prior approval before treatment. Your dentist will talk to you about what is covered at the time of your visit. Covered OHP dental procedures

Dental Care and You

The success of your dental care depends on you. Follow your PCD’s instructions in home care by brushing, and flossing regularly. Return to your PCD for preventive dental care such as cleanings and checkups.

Under OHP Coverage guidelines, dental services may not be approved when the prognosis (outcome) is unfavorable. Your oral health, and follow through in home care will be a factor in coverage decisions.

Emergencies and Urgent Care

• Emergency dental care is dental care that requires immediate treatment.

• Examples are: severe tooth pain, a tooth knocked out and unusual swelling of the face or gums.

• Urgent dental care is dental care requiring prompt but not immediate treatment. Examples are: A toothache, swollen gums, and a lost filling.

• If you have a dental emergency or urgent care need, call your dentist or CDC ‘s toll-free number, 1-800-525-6800 or TTY/voice number (800) 735-2900 or AT&T Operation Service for TTY (800) 855-1155.

• For an emergency or urgent care need after hours call your dentist or CDC. If you are unable to reach your dentist call CDC. An on-call dentist will be available to help you.

• For an emergency while you are away from home, call CDC before you obtain services. 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. Information must verify a dentist on our Plan was not available to provide the dental care.

Concerns, & Complaints

CDC and the dentists on our Plan want to give you the best dental care possible. If you have a complaint with any part of your treatment, follow these steps.

1. Contact your dentist, or a CDC member service representative by phone or in writing. The staff will look into both dental and non-dental problems.
2. We will get back to you within 5 working days.
3. We have 30 days to give you a decision.
4. You need to give us consent to investigate your complaint. Without this consent, we may not be able to help you.
5. All information about your complaint is confidential.
6. If your complaint is about dental care benefits or denial of service, you may also ask for an Appeal and an Administrative Hearing through the State.
7. You must first request an Appeal with the Plan before requesting an Administrative Hearing.
8. Contact your caseworker or a CDC member service representative for details.

Going to a Different Dentist or Changing Dental Plans

Going to a different dentist should be a decision thought over carefully. If you decide to go to a different dentist, wait twelve months from your last check-up with your previous dentist. Your new dentist will want to do a routine exam and that service is limited. A change prior to that time could result in an extra exam charge for which CDC would not pay. Of course this would not apply for an emergency or urgent dental care needs.

To change to another Dental Care Organization (DCO) Plan you must contact your DHS worker.

How Can We Help?

We can help if you do not speak English or are deaf or hearing impaired and need assistance. Call CDC and let us know what assistance you need. If an interpreter is needed for an appointment let your dentist know. Your dentist will call us ahead of time to arrange one.

A member who is deaf, or hearing impaired can call their dentist or CDC through the Oregon Telecommunications Relay Service. This communication service links deaf and hearing impaired with others via the telephone. Dial TTY/Voice (1-800-735-2900), or AT&T Operator Service for TTY (1-800-855-1155) to use this service. Give the operator the phone number you are calling and the call will be relayed. All calls and information are confidential, and the service is offered 24 hours a day at no cost to callers. Long distance calls will be billed accordingly.

A member who is sight impaired can call us at 1-800-525-6800 for an audio tape of this guide, or with any concerns you might have in how to obtain dental care.

If You Have a Special Need    

If you have a special need making it difficult for you to obtain dental care under our Plan, call us for assistance. We work with our partner, Exceptional Needs Dental Services, (www.endsor.com) to address some of our special needs dental care.