Dental Provider Directory

1 H0524_22 NCHMODD_C Kaiser Permanente Senior Advantage (HMO) and Senior Advantage Medicare Medi-Cal (HMO D-SNP) Plans Dental Provider Directory This Directory is current as of February 1, 2022. This Directory provides a list of DeltaCare USA s current network providers for our Northern California service area, which includes all of Alameda, Contra Costa, Marin, Napa, Sacramento, San Francisco, San Joaquin, San Mateo, Santa Cruz, Solano, and Stanislaus counties and parts of Amador, El Dorado, Fresno, Kings, Madera, Mariposa, Placer, Santa Clara, Sonoma, Sutter, Tulare, Yolo, and Yuba counties. If you live in a partly covered county, please see the service area description inside for the ZIP codes that are in our service area. To access DeltaCare USA s online Provider Directory , you can visit For any questions about the information contained in this Directory , please call our delta Dental Customer Service Department at 1-877-644-1774, Monday through Friday, 5 to 6 TTY users should call 1-800-735-2929.

2 To request a hard copy of Kaiser Permanente s Dental Provider Directory , please call our Member Service Contact Center at 1-800-443-0815, seven days a week, 8 to 8 TTY users should call 711. Kaiser Permanente will mail a hard copy of the Provider Directory to you within three (3) business days of your request. Kaiser Permanente may ask whether your request for a hard copy is a one-time request or if you are requesting to receive the Provider Directory in hard copy permanently. If you request it, your request for hard copies of the Provider Directory remains until you leave Kaiser Permanente or request that hard copies be discontinued. This document is available in a different format for the visually impaired by calling our Member Service Contact Center at the number listed above. Table of Contents Section 1 Introduction .. 1 How to get started .. 1 How to change your dentist.

3 1 How to make sure you re covered .. 1 How to get a second 1 Network providers .. 1 How to submit bills for covered care .. 1 How to get emergency Dental care .. 2 What is the service area for Kaiser Permanente Senior Advantage and Senior Advantage Medicare Medi-Cal plans .. 2 How do you find DeltaCare USA providers that serve your area? .. 3 Section 2 List of Network Provider .. 4 ALAMEDA .. 4 ALAMO .. 4 ALBANY .. 4 ANTELOPE .. 4 ANTIOCH .. 4 AUBURN .. 4 BELMONT .. 4 BERKELEY .. 5 BRENTWOOD .. 5 BURLINGAME .. 5 CALISTOGA .. 5 CAMERON 5 CAMPBELL .. 5 CARMICHAEL .. 5 CASTRO VALLEY .. 6 CHICO .. 6 CHOWCHILLA .. 6 CITRUS HEIGHTS .. 6 CLOVIS .. 7 CONCORD .. 7 COPPEROPOLIS .. 8 CORCORAN .. 8 CUPERTINO .. 8 DALY CITY .. 8 DANVILLE .. 8 DAVIS .. 8 DINUBA .. 9 DUBLIN .. 9 EARLIMART .. 9 EAST PALO ALTO .. 9 EL CERRITO .. 9 EL DORADO 9 ELK GROVE .. 10 FAIR OAKS .. 10 FAIRFIELD .. 11 FOLSOM .. 11 FOSTER CITY .. 12 FOWLER.

4 12 FREEDOM .. 12 FREMONT .. 12 13 GALT .. 15 GILROY .. 15 GRANITE BAY .. 15 HANFORD .. 15 HAYWARD .. 15 HOLLISTER .. 16 HURON .. 16 KERMAN .. 16 KINGSBURG .. 16 16 LEMOORE .. 16 LINCOLN .. 16 LIVERMORE .. 17 LODI .. 17 LOS ALTOS .. 17 LOS BANOS .. 17 LOS GATOS .. 17 MADERA .. 18 MANTECA .. 18 MARIPOSA .. 18 MARTINEZ .. 18 MCCLOUD .. 18 MENDOTA .. 18 MENLO PARK .. 18 MERCED .. 19 MILPITAS .. 19 MODESTO .. 19 MONTEREY .. 20 MORGAN HILL .. 20 MOUNTAIN VIEW .. 20 NAPA .. 21 NEWARK .. 21 NORTH HIGHLANDS .. 21 NOVATO .. 21 OAKLAND .. 22 ORANGE COVE .. 22 PALO ALTO .. 22 PARLIER .. 22 PETALUMA .. 22 PINOLE .. 23 PITTSBURG .. 23 PLACERVILLE .. 23 PLEASANT HILL .. 23 PLEASANTON .. 24 PORTERVILLE .. 24 RANCHO CORDOVA .. 24 REDDING .. 25 REDWOOD CITY .. 25 REEDLEY .. 25 RICHMOND .. 25 RIVERBANK .. 26 26 ROHNERT PARK .. 26 ROSEVILLE .. 26 SACRAMENTO .. 28 SALIDA .. 31 SALINAS .. 31 SAN BRUNO .. 31 SAN FRANCISCO .. 31 SAN JOSE.

5 32 SAN LEANDRO .. 36 SAN MATEO .. 36 SAN PABLO .. 37 SAN RAFAEL .. 37 SAN RAMON .. 37 SANGER .. 37 SANTA CLARA .. 38 SANTA CRUZ .. 38 SANTA ROSA .. 38 SARATOGA .. 39 SELMA .. 39 SOUTH SAN FRANCISCO .. 39 STOCKTON .. 39 SUNNYVALE .. 40 TRACY .. 41 TULARE .. 41 TURLOCK .. 41 UKIAH .. 42 UNION CITY .. 42 VACAVILLE .. 42 VALLEJO .. 42 VALLEY SPRINGS .. 43 VISALIA .. 43 WALNUT CREEK .. 43 WATSONVILLE .. 43 WEST SACRAMENTO .. 44 WINDSOR .. 44 WOODLAND .. 44 YUBA CITY .. 44 Notice of nondiscrimination .. 46 Multi-language Interpreter Services .. 47 1 Section 1 Introduction This Directory provides a list of DeltaCare USA s network providers. How to get started delta Dental will match you with a dentist when you join. You'll get a welcome letter in the mail with your dentist's name and address. To make an appointment, just call your dentist's office and let them know you're a member of DeltaCare USA. How to change your dentist If you want to change dentists, choose one from this Directory .

6 You can also find a list of DeltaCare USA dentists at You can change dentists online or you can call delta Dental Customer Service at 1-877-644-1774, Monday through Friday, 5 to 6 (TTY users should call 1-800-735-2929). If we get your request to switch dentists before the 21st of the month, the change will happen on the first of the next month. If we get your request after the 21st, the change will happen on the first after the next month. (For example, if we get your request on April 22, you'll be able to see your new dentist on June 1). How to make sure you re covered If you want your Dental care to be covered, you must get your Dental care from your DeltaCare USA dentist. You may be covered for care with another dentist if you have an emergency or if your DeltaCare USA dentist refers you to a specialist. delta Dental must approve any referral before you get care. When delta Dental approves your referral, you'll get written approval for covered Dental services from a specialist.

7 Neither Medicare nor your plan will cover any other Dental services. How to get a second opinion You may ask for a second opinion if you don't agree with or question your DeltaCare USA dentist's diagnosis or treatment plan. To request a second opinion, please call delta Dental Customer Service at 1-877-644-1774, Monday through Friday, 5 to 6 (TTY users should call 1-800-735-2929). Also, we may require you to get a second opinion from another DeltaCare USA dentist at any time to make sure the care you're getting is necessary and appropriate. Network providers The network providers listed in this Directory have agreed to provide you with your Dental services. You may go to any of our network providers listed in this Directory . The network providers listed in this Directory are part of the network; however, you must receive services from your assigned DeltaCare USA office for services to be covered. Also, some services may require a referral.

8 If you have been going to one network Provider , you are not required to continue to go to that same Provider if you have requested a change in your assigned DeltaCare USA dentist. In some cases, you may get covered services from non-network providers, such as covered emergency care and authorized referrals. However, you must contact delta Dental to receive authorization. How to submit bills for covered care If you get a bill from an out-of-network Provider , don t pay it. Instead, submit it to delta Dental within 90 days of the end of the DeltaCare USA Dental HMO Program Kaiser Permanente has an agreement with delta Dental of California to offer you the DeltaCare USA Dental HMO Program. DeltaCare USA offers a wide range of Dental care through a network of dentists who contract with delta Dental of California. 2 treatment. delta will let you know how much you have to pay. You may be able to submit a bill after the 90-day period if you can show that it wasn t reasonably possible to submit it in time.

9 Send any bills and claim forms to: Claims Department Box 1810 Alpharetta, GA 30023 How to get emergency Dental care If you need emergency Dental care, call your DeltaCare USA dentist or delta Dental Customer Service at 1-877-644-1774, Monday through Friday, 5 to 6 (TTY users should call 1-800-735-2929). Covered emergency care is limited to care needed to stabilize your condition and relieve your pain. If you get emergency Dental care from a dentist who isn't your assigned DeltaCare USA dentist, you re limited to $100 per emergency. If you get emergency Dental care from a dentist who isn t a DeltaCare USA dentist, you re responsible for the full cost of the Dental care unless the following is true: You have made a reasonable attempt to contact your DeltaCare USA dentist and you can't be seen within 24 hours or you don't think you can travel to your DeltaCare USA dentist because of your condition.

10 You call delta Dental Customer Service before you get emergency Dental care, or your condition is so severe that you need to get care without calling Customer Service. You must use your assigned DeltaCare USA network Provider except in the case of an emergency or urgent care situations. If you obtain routine care from out-of-network providers, neither Medicare nor DeltaCare USA will be responsible for the costs. What is the service area for Kaiser Permanente Senior Advantage and Senior Advantage Medicare Medi-Cal plans? The counties and parts of counties in our Northern California service area are listed below. Our service area includes all of Alameda, Contra Costa, Marin, Napa, Sacramento, San Francisco, San Joaquin, San Mateo, Santa Cruz, Solano, and Stanislaus counties and parts of Amador, El Dorado, Fresno, Kings, Madera, Mariposa, Placer, Santa Clara, Sonoma, Sutter, Tulare, Yolo, and Yuba counties. If you live in a party covered county, you are in our service area if your home ZIP code appears here: Amador County: 95640, 95669.