Dental Office Procedures

Dental Office Procedures


The following information will help dental offices with procedures for filing a case through the Humanitarian Foundation, Dental Care for Children with Special Needs program.

1. The child must be under 18 and have one of the following conditions:

Cerebral Palsy
Muscular Dystrophy and related neuromuscular diseases
Intellectual Disabilities, including Downs Syndrome
(Intellectual disabilities covers from profound to two years, overall, developmentally delayed. When submitting under developmentally delayed, a letter signed by client’s physician or preferably a Licensed School Psychologist must accompany the application, stating the current mental age capacity.)
Organ Transplant Recipients (dental treatment, pre & post)

2. Form #1 must be completed by the Parent or Legal Guardian.

3. Form #2 (pre-treatment estimate) must be completed by the dentist. The dentist may submit     a computer printout of the pre-treatment estimate, but it must be attached to the original copy of Form #2.

4. Both forms are sent to the local Grotto Representative, the Dr. of Smiles, for his signature. The Grotto representative will immediately forward both forms to the Humanitarian Foundation for processing. When there is no local Grotto or Dr. of Smiles available, forms #1 and #2 must be sent directly to the Humanitarian Foundation, 430 Beecher Rd., Gahanna, OH 43230-1797.

Please submit to the Grotto representative first, to prevent delay in processing your treatment plan.

5. A letter of approval will be sent directly to your office, or a fee adjustment letter will be sent if the fees are higher than our program will approve. When the fee adjustment letter is returned, a letter of approval will then be sent directly to the dental office. When treatment is completed, the dentist’s office, hospital, anesthesiologist, instructed to send the billing directly to the Humanitarian Foundation at 430 Beecher Rd, Gahanna, Ohio 43230-1797 for payment.

6. Payment will be issued within 30 days after the billing is received. Please make sure that the insurance company is billed first. The Humanitarian Foundation is always the secondary carrier if insurance is available, with the exception of Medicaid recipients, who have full dental benefits (payment in full).

7. A computer printout may be submitted with your dental costs or an EOB form can be sent by the hospital or anesthesiologist.

8. The Humanitarian Foundation does not cover children covered by Medicaid, except in some cases if Medicaid does not cover a specified procedure, it can be considered with a Medicaid denial statement.

9. The Dr. of Smiles will have the forms needed for you to submit the child’s case.

10. A local Grotto will sponsor all of the children that qualify from your office. If there is not a Grotto in your state, the Humanitarian Foundation national office will sponsor the client(s). The Dr. of Smiles will have the necessary forms for the parent and dentist to complete, or they can be found on the web site at

We hope this information will help you. If you have any further questions, please feel free to contact the Humanitarian Foundation at 614-933-0711 or fax: 614-933-0481. You may e-mail the Executive Director at