State of Maryland
Q & A for United Concordia DPPO Members
Are there any benefit maximums? Yes, there is a benefit maximum of $1,500 per member per contract year (July 1st - June 30th). There is a lifetime orthodontia maximum of $2,000 for dependent children. Orthodontia benefits cease at the end of the month in which the dependent child turns 26.
How often can I receive exams and cleanings? Exams and cleanings are covered at a frequency of 2 within a consecutive 12-month period. For example, if you currently have no history of a cleaning and you receive a cleaning on October 4 of this year, you will be eligible for a 2nd cleaning any time during the next 12 months (October 4, 2012—October 4, 2013). However, you will not be eligible for a 3rd cleaning until after October 4 of 2013.
Do I have to fill out claim forms after each routine visit? If you receive care from a Concordia Advantage Plus network dentist, you do not need to fill out claim forms—your dentist will take care of the paperwork. Under the DPPO plan, you must submit claim forms if you are seeking reimbursement for services performed by an out-of-network dentist.
If my dentist does not participate in Concordia's Advantage Plus network, can I still see him or her? Yes, you can receive care from any licensed dentist. If you choose to see a nonparticipating dentist, you will be responsible for the deductible and/or coinsurance amount, as well as any charges over and above United Concordia's reimbursement for covered services. Concordia Advantage Plus network dentists accept United Concordia's reimbursement as payment in full for covered services, which means you are only responsible for the applicable deductible and/or coinsurance amount.
Can I obtain the charge and coinsurance amount for specific services prior to receiving treatment? Yes, simply obtain the ADA procedure code and dentist's charge from your dentist's office. Contact United Concordia's Customer Service Department at 1-888-638-3384 with this information and they can provide you with your financial responsibility for the service, including any deductibles and coinsurance amounts.
How can I obtain a directory of participating dentists? Either call 1-888-638-3384 or click here to view a current listing of participating general dentists and specialists. To receive in-network benefits, members must receive services from dentists in the Concordia Advantage Plus network. You always have the option of receiving care from non-network dentists under the DPPO plan.
Do I have to be referred to a specialist? No. Under the DPPO plan, referrals are not required. To maximize your benefits, you may wish to utilize a participating dentist.
Who is eligible to received fluoride treatments? Eligible dependent children under age 19.
What about orthodontia for children? Orthodontic benefits are available for dependent children through age 26 who are covered under the United Concordia DPPO plan. Orthodontic benefits can be received from participating and nonparticipating dentists. There is a lifetime orthodontic maximum of $2,000 per dependent child. There is no adult orthodontic coverage under the United Concordia DPPO plan.