Frequently Asked Questions
"Schedule of Benefits" is mentioned frequently in the answers below. Please refer to the Home Page to click on "Benefits" for details or
Please feel free to call (813) 879-4949 or toll free (877) 879-4949 with any additional questions you may. Also, the link below is a CompBenefits link for their info on questions. Click below: have.https://www.mycompbenefits.com/static/faqs.html
How do I choose a dentist? There is a list of providers to choose from. (Go to home page and click on providers.) Type in your zip code and how many miles in distance you are willing to travel. This site also tells you if the dentist is accepting new patients.
How do I make an appointment and when? After you have enrolled and received your membership card, call the Dentist you have chosen and make an appointment. Be sure to tell him you are with American Dental Plan. They will be notified of your membership but it still is good to tell them when you call. If you know your effective date, you can call the Dentist and make an appointment for a day after your effective date.
How do I know my effective date? If you are not sure you sent your application in time to be effective for the following month, call member services and ask when your effective date will be. Phone 1-800-342-5209.
How many times a year can I visit my dentist? You are encouraged to visit your dentist regularly. With your dental plan, you are not limited to a specific number of visits per year for services needed. You are however, limited to 2 checkups with x-rays and 2 cleanings.
How do I pay for services? If your visit is for covered preventive care, such as a routine exam, cleaning or x-ray, there is no charge for the procedure; the dentist is prepaid by the ADP program. For other procedures, a small co-payment may be required. See your Schedule of Benefits for amounts. You pay this directly to the Dentist. There is a $5.00 co-pay for every visit regardless of other costs involved. Even no charge visits has the $5.00 co-pay.
Is there a maximum coverage limitation? There are no maximum limitations on benefits.
What if I need a specialist? When treatment by a specialist is required and you visit an ADP participating specialist, you will receive benefits as shown on your Schedule of Benefits. We make every effort to ensure there is a complete range of specialty care in each geographic area. However, it is not always possible to secure some specialty types in some areas. Please check with our Member Services Department to verify that a particular specialty is available. 1-800-342-5209
What is the cost for specialists? You will receive a 25% reduction from usual and customary fees for services performed. However, there is a group plan that offers the same charges with specialists as with your primary dentist. These are only for CS150 group enrollees.
What type of specialists are there? Endodontist, Orthodontist, Oral Surgeon, Periodontist, Prosthodontist and Pedodontist. If you are unsure of their specialized field, please call member services at 1-800-342-5209.
Can I change dentists? Yes. You can easily change dental offices by contacting ADP. A simple phone call is all it takes. 1-800-342-5209. We hope, of course, you have a valid reason for the change as you may be asked.
How do I know the cost for a certain procedure? Review your Schedule of Benefits with your dentist or click on the Benefits page on the home page of this web site. You will always know what to expect. And often, you can expect no charge because preventive care is no charge. (A $5.00 co-pay is for every visit.) Click on this link: http://www.floridadentalinsurance.com/benefits.htm
What if I need to cancel an appointment? Please call your Dentist at least 24 hours before your appointment. If you break an appointment without giving 24-hour notice to your Dentist office, you may be charged for a broken appointment at the rate shown on your Schedule of Benefits.
What if I want a second opinion? You may get a second opinion from one of our Participating General Dentists at the cost indicated on your Schedule of Benefits. Call the Dentist and let the receptionist know that you would like a second opinion appointment. Be sure to tell her that you are an ADP member. The dentist will evaluate your situation and discuss it with you. If any services are rendered, you will be responsible for the cost.
What should I do if I have a change of address? Simply notify Member Services by phone or letter if your address or telephone number changes.
What is the difference between prophylaxis and periodontal prophylaxis? Prophylaxis (ADA code #1110) is a routine cleaning. It includes scaling and polishing of teeth with normal periodontium (gun attachment and bone support). Periodontal Maintenance Procedures (ADA code #4910) are maintenance procedures which are often necessary for those patients who have treatment for periodontal problems such as gum disease or pyorrhea and require follow up care. These follow up appointments are not the same as a routine cleaning. It is a more extensive scaling process. There is a scheduled co-payment for this procedure.
What happens if I am covered by dental insurance in addition to my coverage with American Dental Plan? ADP will typically be your primary coverage. However, you may want to file your "out-of-pocket" expenses with your other carrier. Please contact your other carrier for information about how they would like for you to handle this.
What will I pay for a crown or a bridge? The amount you pay depends on the type of crown or bridge your Dentist recommends for you. The co-payment on your Schedule of Benefits may not include the price of gold. If your crown or bridge includes gold, there may be an additional charge. Discuss this with your dentist prior to the procedure being performed.
NOTE: When crown and/or bridgework exceeds six consecutive units, the patient may be charged an additional $25.00 per unit.
What if I need emergency treatment? Call your dentist for an appointment. The Schedule of Benefits shows the co-payment for an emergency appointment.
What are the details on vision. The enhancement package is no longer available. However, you can still enroll in the vision program at a minimal monthly premium. 1-877-879-4949
What if I have other questions? We have qualified staff, trained to answer your questions. Please contact member services for further information. 1-800-342-5209
Our member service staff is ready to assist each member via our toll-free number. The following types of assistance are typically handled by the member services department:
1-800-342-5209
Information regarding the certificate of benefits.
Information and assistance regarding the dental network.
Obtaining second opinions on request.
Obtaining emergency dental services.
Formal grievance process.
Resolving issues with dental offices.
Member service issues are monitored continuously by our provider relations department. This is done on an ongoing basis through direct daily involvement and periodic member satisfaction surveys.
ENJOY YOUR MEMBERSHIP!
Call (813) 879-4949 or toll free (877) 879-4949 with other questions.
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