What dental services, procedures are covered under OHP?
What is my covered benefit for a dental exam and cleanings?
One visit per year for exam and cleanings.
Are extraction, x-rays and fillings a covered benefit?
Yes.
Do any services have to be pre-authorized before having the care done?
Yes. Major services such as dentures and crowns have to be pre-authorized.
Are crowns a covered benefit for baby teeth?
On baby teeth (primary teeth) only stainless steel crowns are covered.
What kind of crowns are a covered benefit for permanent teeth?
On back teeth only stainless steel crowns are covered. On front teeth tooth colored and stainless steel crowns are covered.
If I want a different type of crown than the ones covered may I pay the difference?
No. If for example you want a porcelain crown on a back tooth where only a stainless steel crown is a covered benefit, you would have to pay the entire amount for the service.
Who are my choices of dentists?
Provider List
May I choose a dentist without calling or emailing first?
No. Not all dentists are accepting patients at any one time. Please email or call our Member Services department first to select a dentist.
How do I schedule an appointment?
After you have been given a name of a primary care dentist then call the dentist's office to make an appointment.
What if I already have a dentist but he/she is not on your list of dentists?
Going to a dentist not on the MDCO plan without approval could result in your bill not being paid. This may mean you would have to pay the bill.
What should I do if I cannot keep my appointment?
If you will not be able to keep your appointment, call and cancel at least 24 hours in advance of the appointment. MDCO takes missed appointments very seriously.
Whom do I call if I have an urgent or emergency dental care need after hours?
Call your dentist. If you are unable to reach your dentist call MDCO. An on-call dentist will be able to help you.
What if I have a dental emergency while I am out of town?
If you have a dental emergency, call your primary care dentist. If unable to reach your primary care dentist or you do not have one, call MDCO’s toll-free number, 1-800-538-9604 or TTY/voice number (800) 735-2900 or AT&T Operation Service for TTY (800) 855-1155. An on-call dentist will be available to help you. 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.
Whom do I contact if I have a complaint with any part of my treatment?
MDCO 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 MDCO 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 you have been denied a service, you may request an appeal, or request an administrative hearing through DMAP within 45 days from the date of the decision notice.
  7. MDCO will review your appeal and give you a decision within 16 days.
  8. If you disagree with our appeal decision an administrative hearing can be requested within 45 days of the notice.
  9. If at any step in this process, your problem is solved, you need to contact the DMAP Hearings Representative.
  10. If you believe your dental complaint, or appeal is an emergency and cannot wait for review let MDCO know or call your DHS worker. MDCO 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.
How do I go about changing dentists?
It is important to develop a relationship with your primary care dentist. Going to a different dentist should be thought over carefully. MDCO allows a member to change twice. A third change requires a request to MDCO with a valid reason, and our approval. 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's benefit is limited. A change prior to that time could result in an extra exam charge for which MDCO would not pay. Of course this would not apply for an emergency or urgent dental care needs.
How do I go about changing to a different Dental Care Organization (DCO)?
To change to another Dental Care Organization (DCO) Plan you must contact your DHS worker.
I have special needs that make it difficult to obtain care. What are my options?
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.