Frequently Asked Questions

Benefit Questions

What is a Dental HMO?

• A Dental HMO (sometimes called a DMHO or “prepaid plan”) is a dental plan that has the goal of helping Members achieve and maintain good levels of dental health, and prevent future dental problems. Unlike traditional insurance, DHMOs don’t have deductibles and typically don’t have annual maximums for general dentistry services. Preventive services such as exams, x-rays, and prophylaxis cleaning, typically have low or no copayment; other procedures such as fillings, crowns, extractions, etc. will have reduced fee copayments associated with them.    Members in dental health maintenance organizations are encouraged to see their providers regularly to receive preventive services to maintain a level of dental health that will minimize the need for more expensive services.

What are my benefits?

• Your benefits are designated by a plan name or number on your ID card and are defined in a co-payment schedule within your summary of benefits or Explanation of Coverage. Your schedule of benefits is also available on line here.

What is a co-payment?

• A reduced fixed fee, that Members are responsible to pay the general dentist or specialist at the time of treatment. The copayment schedule is listed by procedure code in your Benefits Schedule or can be found here.

What services does my plan cover?

• Your California Dental Network plan provides coverage for comprehensive general and specialty care dental services at no charge or reduced fees. Covered services include exams, x-rays, cleanings, fillings, crowns, bridges, dentures, extractions, root canals, gum treatment, orthodontics and implants.  See your Evidence of Coverage for the details of your plan coverage.   Recommended and covered treatment will be based on the treating dentist’s determination of your condition.  Members may elect a more expensive treatment, but will be responsible for the cost difference.

Are there waiting periods?

• There are no waiting periods for any services under your plan.  Please check your Benefits Schedule, or call Member Services, for a list of other limitations and exclusions that may apply.

What are the limitations and exclusions?

• Some procedures listed on your Schedule of Benefits are subject to limitations and exclusions. Limitations and Exclusions of your Benefit Plan can be found in your Evidence of Coverage. You can also find them online here.

What if I have a pre-existing condition?

• Typically, pre-existing conditions are not excluded. For example, your plan covers the replacement of teeth missing prior your effective date of coverage. The Limitations and Exclusions of your benefits plan, contained in your evidence of coverage (or you can find them here) explains which, if any, pre-existing conditions are excluded from your coverage.

When should I obtain a pre-treatment estimate?

• Generally pre-treatment estimates are not needed for treatment provided by your contracted general dentist. Your schedule of benefits lists all covered procedures, as well as the co-payments for each procedure. If you are being quoted a fee that is higher than the listed copayment for a procedure, contact Member Services for clarification and assistance prior to starting treatment.

How do I receive emergency care?

• The Plan covers emergency dental services 24 hours a day, seven days a week, for all members. You should contact your assigned dentist to arrange for emergency care. If your assigned provider is unavailable during normal business hours call CDN’s office for instructions toll-free at 1- 855-425-4164. In the event of an after-hours emergency, and you are unable to reach your selected provider, you may obtain emergency services from any licensed dentist. Coverage for such care is limited to services needed to relieve the emergency pain, bleeding, or swelling condition and does not include definitive restoration (such as complete root canal, permanent filling or crown). For reimbursement of emergency care send a copy of the bill, evidence of payment, and a brief explanation of the unavailability of your provider to California Dental Network at 23291 Mill Creek Drive Suite 100, Laguna Hills, CA 92653. Upon verification of your Provider’s unavailability CDN will reimburse you for the cost of emergency services less the applicable copayment.

Is orthodontia included?

• California Dental Network covers orthodontia on most of its Benefit Schedules, subject to benefit plan limitations and exclusions. You can check here for your plan’s coverage. You can also review your Schedule of Benefits or contact Member Services Department at 1-855-425-4164.

Is cosmetic treatment included?

• California Dental Network plans typically covers many dentally necessary procedures that are also cosmetic, such as tooth colored crowns, upgrading to more cosmetic materials than the basic covered benefit at listed copayments (e.g., tooth-colored fillings on back teeth).  Treatment that is performed solely for cosmetic reasons, as determined by the treating dentists, is typically not a covered benefit (for instance placing veneers on teeth that have no decay or other damage, changing sound silver-colored fillings to tooth colored fillings). You can check here to see which services may be available on your plan.

Is there an annual maximum to my benefits?

• There are no annual benefit maximums for dental care covered at the general dentist’s office. There are limitations on how often some of the listed procedures can be performed in a given time period, which are explained on the Schedule of Benefits and the Limitations and Exclusions of your plan. Care received from a specialist does have annual dollar maximums on some Benefit plans. You can see the Limitations and Exclusions and the Specialty Care coverage for your benefit Plan

Dentist Questions

How do I make an appointment?

• Once you are eligible, and have been assigned to a contracted provider, call your dentist to schedule an appointment. Be sure to identify yourself as a member of California Dental Network when you call. The dental office should have a copy of your benefit schedule and we also suggest you keep your Evidence of Coverage and Schedule of Benefits to help you can determine your benefits and applicable co-payments before or during your appointment.

How do I select or change a dentist?

• You can search online for participating dentists by clicking here (program). After selecting a general dentist contact the Member Services department toll-free at 1-855-425-4164 to request assignment to your chosen provider. All family members must use the same office.  Requests received by the 20^th of the month will generally become effective on the first day of the following month.

Can I go to my own dentist?

• Your plan benefits are only available from a California Dental Network contracted dentist. If your current dentist is not contacted with California Dental Network you will not be eligible for dental care at reduced fees in that office.

Can my dentist join your network?

• California Dental Network will be happy to contact your dentist about joining our network. Please give your dentist information to Members Services at 855-425-4164 or via email at membership@caldental.net

Who can me help understand a dental procedure?

• The best place for help understanding any dental procedures is the dental office itself. California Dental Network recommends that you ask questions during your examination, and encourages you to contact the office again before receiving treatment if you have questions. Click here for an explanation of some major procedures.   You can also call Member Services for assistance before, during or after an appointment at 1-855-425-4164.

Do I need an ID card to visit the dentist?

• It is recommended. Your ID card tells your dentist the plan you’re enrolled on to ensure you’re charged the correct co-payment.  Your ID card also includes our Member Services number if you or your dental office have questions.

Member Services Questions

Who do I call if I have questions?

• Should you have a question, a Member Services Representative will be glad to assist you before, during or after an appointment. Member Service Representatives are available Monday through Friday 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 6 p.m. at 1-855-425-4164. You can also send an e-mail to us by clicking here.

How can I get a copy of my ID card?

• Once payment is received your ID card will be mailed to you as part of your new member packet. If you lose your ID card, a replacement can be ordered by contacting Member Services at 855-425-4164.

Who are eligible dependents?

• Your spouse or domestic partner
• Unmarried dependent children up to the age of 26
• Disabled children (over the age of 26) dependent upon you for support and  unable to support themselves due to physical or mental handicap
• Adopted or step children meeting the above requirements

How do I change my address?

• Please call the Member Services Department at 1-855-425-4164.

How do I get translation assistance?

• Many California Dental Network providers have the ability to provide care in languages other than English. When selecting a general dentist at the Plan’s website here you can see if the office offers staff who speak your preferred language. You may also request language assistance at no charge to you by calling Member Services Department at 1-855-425-4164.

How do I get assistance for the hearing impaired?

• Dial 711 to call the Telecommunications Relay Services.

What if I cannot find a dentist in my area?

• Please contact Member Services at 1-855-425-4164 if you would like assistance locating a general dentist in your area.  If you require specialty care, your network general dentist will request authorization from the Plan for referral to a network specialist.  If there is no contracted specialist available near you for covered, approved care, please contact Member services for assistance in obtaining covered, approved, care from an out of network specialist .