ADP : Maxillofacial Prostheses (Facial and Mouth Prostheses)

ADP covers part of the approved cost for selected extraoral (facial) and intraoral (mouth) maxillofacial prostheses.

Any resident of Ontario with a valid Health Card issued in his or her name who needs a facial or mouth prosthesis due to a congenital or acquired condition.

ADP does not pay for equipment available under the Workplace Safety & Insurance Board or to Group 'A' veterans for their pensioned conditions.

You begin by getting an ADP Equipment/Supply Authorization form by calling ADP at one of these numbers :

You can also pick up this form from an ADP registered authorizer or vendor. ADP has a list of their names and numbers.

No. You complete the first part called Biographical Information. Then you sign and date Section 4 of the form.

If you need a maxillofacial extraoral prosthesis, you must be examined by a doctor, who is a specialist in plastic surgery, ophthalmology, oncology or otolaryngology.

If you need a maxillofacial intraoral prosthesis, you must be examined by a dentist or a doctor, who specializes in this area.

The dentist or doctor will prescribe the device in the second part of the application. You then go to an authorizer/vendor registered with ADP.

The authorizer/vendor will complete the third and fifth parts of the application and make the prosthesis.

When your prosthesis is ready, you will be billed for at least 25 per cent of its approved cost.

If you are receiving social assistance benefits under Ontario Works (OW), Ontario Disability Support Program (ODSP) or Assistance to Children with Severe Disabilities (ACSD), you may be eligible to receive more money.

Not always. If the vendor's retail price is more than the maximum amount that ADP will pay on your behalf, you will be responsible for the difference. Be sure to ask your vendor how much of the total cost you will be responsible for.

ADP will pay part of the cost if a new maxillofacial extraoral prosthesis is needed because your medical condition or body size has changed significantly. Your specialist must state the need for this.

In the case of a maxillofacial intraoral prosthesis, your Doctor or dentist must state the need for adjustments or replacement prostheses. All adjustments for the first three months are included in the cost of the prosthesis.

Otherwise, ADP will cover a portion of the cost of a new maxillofacial prosthesis at the end of a set period, if a new one is needed.

ADP does not pay for replacement where the original equipment is lost, stolen, or damaged due to misuse. You are encouraged to buy insurance for coverage in these situations.

July 2004 Cat. No. 2104123