Care-Plus Dental Plans, Inc.

RevDex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below
Please see attached
Regards,
*** ***

We have received the complaint made to your organization.  Before we can respond, would you please have the complainant complete the attached authorization to disclose Personal Health Information.  Upon receipt of the authorization, we will send our response to the complaint.

Dr. [redacted] has forwarded a copy of her response to Ms. [redacted]'s complaint to theCarePlus Grievance Committee.Services rendered by an out-of-network provider are not a covered benefit of theCarePlus policy Ms. [redacted] is enrolled in without prior-authorization or approval, unless itis for emergency treatment outside the service area. However, upon review, thecommittee has authorized additional payment for the services rendered to her.We apologize for Ms. [redacted]'s dissatisfaction with the services provided by DentalAssociates and the benefits provided in her CarePlus managed care policy. In the future,Ms. [redacted] must receive fonnal written prior approval before seeing any out-of-networkproviders, including any specialty providers from CarePlus Dental Plans. In addition, weask that she use the grievance process indicated in her policy for appeals should the needarise.We suggest that Ms. [redacted] contact the Dental Associates Clinic [redacted] or [redacted] at the [redacted] facility if she requires additional dental treatment or hasconcerns about the quality of care she has received.

Review: I have dental insurance through my spouse with Care Plus Dental Plans, Inc. I needed endodontic treatment and received a referral to an endodontic specialist, made by a Dental Associates dentist. This dentist examined me and determined that I needed to receive treatment by an Endodontist. Care Plus Dental Plans, Inc. has refused to pay for my treatment on the basis of receiving treatment out of network. Instead of allowing me to receive appropriate treatment by a qualified dentist with the necessary expertise, I received a telephone call from Dental Associates office for me to make an appointment to extract my tooth. I believe the members of Dental Associates who have dental insurance with Care Plus Plan, Inc. deserve better care than they now receive. Members should not be subjected to care from a dentist whose expertise is outside his/her scope of practice. Thus compromising their dental health by having unnecessary dental extraction when restorative treatment is the treatment of choice.Desired Settlement: I would like to see Dental Associates provide dentist who specializes in endodontic in eastern Wisconsin and not subject members to limited treatment because general dentists are practicing outside their scope of practice. Also, When members require specialty care, that care should be paid for by Care Plus Plan, Inc.

Business

Response:

We have received the complaint made to your organization. Before we can respond, would you please have the complainant complete the attached authorization to disclose Personal Health Information. Upon receipt of the authorization, we will send our response to the complaint.

Consumer

Response: