California Dental Plan, New Dental Choice Provider Choices

Sunday, May. 8th 2011 6:20 AM

a) Each Member must use a Participating Provider in order to receive services. The Plan does not assign Members to Participating Providers and Member is free to select and receive Dental Care Services from any Participating Provider. Participating Providers for Member’s geographic area may be located using Plan’s website or by telephoning the Plan at 1-888-NDC-ENROLL (1-888-632-3676). The Plan maintains an extensive network of general dentists and specialists. In most geographic areas there are specialist dentists in reasonable proximity to where Members reside. In some more rural areas, however, some specialties may not be available. Should the need arise, Members should call the Plan or consult the Plan’s website to determine where a particular specialty may be found in the Member’s area.

b) The Plan does not require notification from the Member if Member wants to change from one Participating Provider to a different Participating Provider. These rules of selection and freedom to change Participating Providers apply both to general dentists and to specialists. Member shall be solely responsible for any charges for any dental treatment received from a Non-Participating Provider under any circumstances or for any reason.

c) Unless the Member or the Plan requests otherwise, a Participating Provider withdrawing or being terminated from the Plan is obligated to provide, following the date of his or her termination from the Plan, Dental Care Services to a Member in the course of commenced but uncompleted treatment by the Provider on the date of such withdrawal or termination from the Plan at the discounted fees to which the Member is entitled under this Agreement until the course of treatment has been completed.

d) Should the Plan cease to be in business, the Participating Provider is obligated to continue to provide Dental Care Services to Members at the discounted fees to which the Member is entitled under this Agreement until the Member’s paid annual membership terminates.

e) The Plan will post on its website the names of Participating Providers who (1) have given notice to Plan that they intend to withdraw from the Plan’s provider network; (2) are being terminated from the Plan; or (3) become unable to perform as a Participating Provider This notice under normal circumstances will be posted no less than sixty (60) days before the Provider will cease to be a Provider in the Plan, although in instances where the Provider is being terminated for reasons of cause or otherwise becomes unable to perform as a Provider, the website notice may be posted in fewer days. Therefore, Members are encouraged to consult the Plan’s website to determine the status of a particular Participating Provider, or they may call the Plan’s toll-free number and speak with a Member Services Representative (1-888-632-3676).

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Posted on Sunday, May. 8th 2011 6:20 AM | by Share of Cost | in Share of Cost | No Comments »

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