Delta Dental of California Enterprises

Initial Business Response / [redacted] (1000, 7, 2015/08/11) */ Re: Complaint Case Number: XXXXXXXX Consumer: [redacted] Dear Revdex.com Dispute Resolution Department: A copy of your e-mail sent July 24, to Delta Dental Insurance Company re the above matter was recently forwarded to Delta Dental of California (DDC), Federal Government Programs Mrs [redacted] is enrolled in the TRICARE Military Retiree Dental Program administered by this company out of its Sacramento offices This program offers dental benefits to certain retired military personnel and their dependents, as authorized by U.S.C§1076cBy federal regulation (CFR §199.22), the Department of Defense has determined that state and local laws and regulations pertaining to health or dental insurance are preempted under the auspices of U.S.C§Delta Dental therefore respectfully asserts that the Revdex.com lacks jurisdiction over this aspect of the complaintHowever, in the interest of Customer Service, we will be responding directly to the complainantThe claims in dispute have been adjusted and the applicable payment issued Thank you for your attention to the abovePlease advise if you require additional information Sincerely, [redacted] Program Analyst Delta Dental of California, Federal Government Programs (XXX) XXX-XXXX

April 20, [redacted] Re: [redacted] To whom it may concern: Thank you for your inquiry received April 11, We appreciate the opportunity to respond to your concernInformation cannot be released to another individual unless [redacted] authorizes the release As a result, we are unable to respond to your concern at this time, as there is no release on file Please note, we have opened a grievance for Ms***, and will be responding directly to the member no later than May 10, This privacy restriction is the result of the U.SDepartment of Health and Human Services (HHS) Office for Civil Rights, which announced this rule effective September 23, This privacy rule was created to strengthen the privacy and security protections for health information established under the Health Insurance Portability and Accountability Act of (HIPAA)This restriction means that no Personal Health Information (PHI) belonging to another person can be released to another individual unless the owner of the PHI has provided permission to do so If you have any questions or concerns regarding this matter, you may contact me directly at [redacted] , extension *** Sincerely, [redacted] ***Appeals SpecialistSubscriber Services

Mr***,In review of the letter you received from BENEFEDS, it is administered by Long Term Care Partners, not Delta Dental We have no record of you being covered under our Delta Dental PPO plan for Federal employees We only have record of you being covered under DeltaCare only Please contact BENEFEDS at the [redacted] number to address your concerns Thank you,Quality Management

Initial Business Response / [redacted] (1000, 10, 2015/08/17) */ Re: Complaint Case #: XXXXXXXX Consumer: [redacted] Dear Revdex.com Dispute Resolution Department: A copy of your email dated August 12, to Delta Dental Insurance Company re the above matter was recently forwarded to Delta Dental of California (DDC), Federal Government Programs Mr [redacted] is enrolled in the TRICARE Military Retiree Dental Program administered by this company out of its Sacramento offices This program offers dental benefits to certain retired military personnel and their dependents, as authorized by U.S.C§1076cBy federal regulation (CFR §199.22), the Department of Defense has determined that state and local laws and regulations pertaining to health or dental insurance are preempted under the auspices of U.S.C§Delta Dental therefore respectfully asserts that the Revdex.com lacks jurisdiction over this aspect of the complaintHowever, in the interest of Customer Service, we will be responding directly to the complainant to advise Mr [redacted] we have honored his request for early disenrollment from the TRDP We hope this information is helpfulPlease advise if further information is needed Sincerely, DELTA DENTAL of CALIFORNIA Special Correspondence Unit Federal Government Programs Initial Consumer Rebuttal / [redacted] (2000, 12, 2015/08/19) */ (The consumer indicated he/she ACCEPTED the response from the business.)

June 26, [redacted] *** [redacted] RE: Complaint#: [redacted] Complainant: [redacted] Dear Mr***: Delta Dental Insurance Company is in receipt of your correspondence regarding the above-referenced complainant It appears that this inquiry was sent to us in error Based on the information included with the correspondence, it appears the complainant is covered under a dental program administered by Delta Dental of WisconsinPlease forward the attached correspondence to the appropriate plan for resolution [redacted] We appreciate your cooperation in this matter Sincerely, [redacted]

Initial Business Response / [redacted] (1000, 5, 2015/07/23) */ The enrollee's issue has been resolved Initial Consumer Rebuttal / [redacted] (2000, 7, 2015/07/30) */ (The consumer indicated he/she ACCEPTED the response from the business.)

Complaint: [redacted] I am rejecting this response because:I want Delta Dental to fax me a copy of my authorization to allowing auto pay using my Safe Checking I only signed an authorization for DeltaCare USA for autopay from Safe Checking account Bottom line: I want to canel Delta Dental and keep DeltaCare USA with autopay that I signed and autorized Again, please cancel Delta Dental as I autopay with DeltaCareUSA and obviously do not dental insurance Please advise ASAP Thank you Sincerely, [redacted] ***

Complaint: [redacted] I am rejecting this response because:Date Sent: 4/28/12:00:AM Just received letter this morning from Benefeds who administers Delta Dental It was dated 4/19/ I have attached it Received my direct deposit from OPM retirement and another $was taken from it for May So far, they have taken $without my authorization Apparently, they will continue to take $monthly dental insurance In fact the attached correspondence indicates they will take out another $to catch up for prior months that they could not collect because they did not have my written authorization for monthly allotments It wasn't until I signed a written authorization for DeltaCareUSA to take monthly allotments from my pension Delta Dental used that written authorization from DeltaCareUSA to enable them to take $from my monthly pension DeltaCareUSA was only $25+ monthly allotment Please advise, as it has been days already from April 23, to make a decision to cancel Delta Dental premiums through unauthorized monthly allotments.Sincerely, [redacted] ***

To whom it may concern, In response to your request concerning [redacted] , we have opened a grievance in regards to the members service in questionWe are in the process of requesting records certified from the provider Dr [redacted] Once we receive the information requested, we will send a response to Ms [redacted] and the provider with our determination Thank you for your assistance Sincerely, Delta Dental of California Quality Assessment Department

August 4, Revdex.com, Inc [redacted] Re: [redacted] Case ID: [redacted] To whom it may concern: Thank you for your inquiry received August 1, We appreciate the opportunity to respond to your concern Information cannot be released to another individual unless [redacted] authorizes the release As a result, we are unable to respond to your concern at this time, as there is no release on file Please note, we have an open a grievance for Ms***, and will be responding directly to the member no later than August 8, This privacy restriction is the result of the U.SDepartment of Health and Human Services (HHS) Office for Civil Rights, which announced this rule effective September 23, This privacy rule was created to strengthen the privacy and security protections for health information established under the Health Insurance Portability and Accountability Act of (HIPAA)This restriction means that no Personal Health Information (PHI) belonging to another person can be released to another individual unless the owner of the PHI has provided permission to do so If you have any questions or concerns regarding this matter, you may contact me directly at ( [redacted] , extension *** Sincerely, [redacted] Appeals Specialist Subscriber Services

Complaint: [redacted] I am rejecting this response because:there is no one form on their website to fill out to log my complaint for the refund I have been waiting for since 4/25/after phone callsI will call them once again but every phone call response from delta dental is "check is processed and it will take to days to receive" Sincerely, [redacted] ***

Complaint: [redacted] I am rejecting this response because: Hello, As of this writing, April 24, @ 4PM, no response whatsoever Sincerely, [redacted] ***

Complaint: [redacted] I am rejecting this response because:Of the fact that they claimed that I needed to sign a release form that was never mentioned to me to signThis really unacceptable as I know this isn't coming from an actual person and they are using this tactic to delay a resolution furtherWhy am I being held responsible for the fact that this company made an error at my expense? who do these people think they are? This company is dishonest and not upfront with people in regards to there policies and will do anything to line there own pockets with there claimants money at the claimants expenseToday as a result of this I spoke to a person named [redacted] who supposedly got my complaint and was very rude in talking over me as all I wanted to know what was going onI really don't know why this company will not do the right thing and correct the error and properly reimburse my dentist and acknowledge there mistake in misquoting my benefits and coverageUnfortunately, I am stuck with this dental insurance as I need further dental work and I can't afford to wait another months for some coverage to kick in to deal with some cavities from a different insuranceShould this company attempt to deceive me again, I will be seeking out legal help Sincerely, [redacted] ***

May 2, [redacted] Re: [redacted] *** Case ID#: [redacted] To whom it may concern: Thank you for your follinquiry received April 26, We appreciate the opportunity to respond to your concern Information cannot be released to another individual unless [redacted] authorizes the release As a result, we are unable to respond to your concern at this time, as there is no release on file Please note, we have opened a grievance for Ms***, and have responded directly to the member on May 2, This privacy restriction is the result of the U.SDepartment of Health and Human Services (HHS) Office for Civil Rights, which announced this rule effective September 23, This privacy rule was created to strengthen the privacy and security protections for health information established under the Health Insurance Portability and Accountability Act of (HIPAA)This restriction means that no Personal Health Information (PHI) belonging to another person can be released to another individual unless the owner of the PHI has provided permission to do so If you have any questions or concerns regarding this matter, you may contact me directly at [redacted] , extension *** Sincerely, [redacted] Appeals Specialist Subscriber Services

Complaint: [redacted] I am rejecting this response because:Because of the fact that this is ridiculousIt was never communicated to me by the this company that I needed to sign any release and as far as I am concerned this is a shady tactic to delay a resolution and too put me out of pocket for a dentist benefit that was misquoted to me by a benefits agentThis is an under handed tactic and as far as my concern this company is only trying to take my money without my permission and they are running a dental insurance scamBut I know my rights as a consumer and I work in the world of medical insuranceI will press forward with this until this company does the right thing and compensate me for the fact that they messed upIf they think that I am going to go away or get bored with this, they are sadly mistaken, because should they not correct this mistake that they made at my expense, I will be seeking legal help Sincerely, [redacted] ***

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to meSincerely, [redacted]

Revdex.com:I have reviewed the response and have attached the claim formThe Patients name is *** *** date of birth **/**/*** and her ID number is *** Through Delta Dental You should now be able to locate the patient
Sincerely, *** ***

Please see attached

July 12,
Revdex.com of San Francisco Bay Area and
*** *** *** *** *** *** *** *** **
***
RE: Patient: *** *** *** *** ***
BB Case ***
Dear Revdex.com:
This letter is in response to your correspondence concerning the above referenced complainantAs this issue pertains to Private Health Information (PHI) we are unable to respond directly to the Revdex.com. We will accept this as a formal complaint and respond directly to the member.
This privacy restriction is in compliance with the U.SDepartment of Health and Human Services (HHS) Office for Civil Rights, which announced this rule effective September 23, This privacy rule was created to strengthen the privacy and security protections for health information established under the Health Insurance Portability and Accountability Act of (HIPAA)This restriction means that no Private Health Information (PHI) belonging to another person can be released to another individual unless the owner of the PHI has provided specific permission to do so.
Delta Dental takes enrollee concerns seriously and maintains an internal grievance process to review complaintsAs always we recommend that our enrollees submit matters for our review by either contacting customer service at *** to submit a grievance over the phone or request a grievance packet to submit it in writing or submit the grievance online on the following page of our website: ***
Sincerely,
*** ***
Appeals Specialist
Subscriber Services

February 23, *** * *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** *** RE: ID:
*** *** *** * *** Dear Sir/ Madame: Delta Dental Insurance Company is in receipt of your correspondence regarding the above-referenced complainant. We were unable to locate the complainant in our systemTherefore, in order for us to investigate further we ask that you please provide the following information listed below Member Identification NumberMember date of birthCopy of the claim and/or Explanation of Benefit (EOB) We appreciate your cooperation in this matter Sincerely, *** *** Review Assistant Quality Assessment Department