Delta Dental of Massachusetts

Delta dental of Massachusetts is in receipt of the inquiry from the Revdex.com on behalf of our memberAs the administrator of dental benefits we are committed to the privacy and security of patient health informationBased on the information provided by the Better Business Bureau we will investigate the concerns of our member and contact them directly regarding the outcome

Delta Dental of Massachusetts has provided a response to the subscriber via U.SMail regarding the check number of the refund that issued

As the As the administrator of dental benefits Delta Dental of Massachusetts is committed to the privacy and security of our members personal health informationAs such, we will respond directly to our member regarding their complaint will

Delta Dental of Massachusetts is in receipt of your inquiry regarding Ms [redacted] ***Delta Dental of Mass is limited to a general review mostly related to the participating agreement with the dentist that encompasses the accurate submission of claims for completed services, general quality of care and the proper collection of the co payment that is based on the participating provider's agreement with Delta Dental and the member's benefit planAs the administrator of the dental benefits we are careful not to dictate treatment, instead we pay benefitsif applicable, based on services rendered as agreed upon between the dentist and the patientA review of Ms***'s claim history indicates a claim submitted on her behalf by [redacted] ***, the procedure was for a restorative filling on tooth #on the date of service 12/15/The submitted charge for this procedure was and the contracted allowance is In our agreement with Ms***'s employer, this dental plan has an annual deductible of 100.00, $was applied to this claim, however because the deductible has not yet been satisfied; the member is responsible for the submitted charge of $A review of our internal communications indicates that Ms [redacted] inquired via email to Delta Dental regarding this claim and was informed on 2/12/that she had not yet reached her deductible and was responsible for the chargeDelta Dental confirms this claim was processed in accordance to our agreement with Ms***'s employerShould she dispute the applicable $deductible she should seek clarification regarding the terms of her dental coverage and her employerIt is my that this letter has addressed the inquiry of the Revdex.com on behalf of Ms***

The bottom line is the company didn't make a truly hard attempt in notifying me about the increased premium per month (which was an increase of less than $per month), but they did find an active address to send my coverage cancellation letter Is this the type of customer service we deserve? I don't think so I would like to speak with a higher supervisor in the Delta Dental company instead of a customer service rep I've been a paying member for years and to have my coverage cancelled for not paying a premium increase of less than $per month is not right, and to say it was my responsibility to ensure my mailing address was updated thus leading to this cancellation Things happen beyond our control but we still ensure we do the right thing when taking care of people This cancellation is wrongI would like to speak with a higher supervisor in the Delta Dental company I will also be contacting the Mass Consumer Affairs and Business Regulation, Division of Insurance about this situation Regards, [redacted]

Revdex.com: I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted] Almost a week has passed and I still haven't been contacted by Delta Dental If past practice is an indicator , I don't believe that they intend to do so It doesn't seem as if their response is even relevant in this matter and welcome any additional help you can provide to resolve this situation Thank You [redacted] ***

As As As the AAs the administrator of dental benefits, Delta Dental of Massachusetts is committed to the privacy and security of patient information. As such, we provide a response directly to our member regarding their complaint

Delta Dental of Mass is limited to a general review mostly related to the participating agreement with the dentist that encompasses the accurate submission of claims for completed services, general quality of care and the proper collection of the co payment that is based on the participating
provider's agreement with Delta Dental and the member's benefit planAs the administer of the dental benefits we are careful not to dictate treatment, instead we pay benefits, if applicable, based on services rendered as agreed upon between the dentist and the patientCoordination of benefits (COB) occurs when a patient has insurance coverage through tow plans and the coverage through two plans and the from both of these plans is coordinated so that the member receives the maximum allowable benefit under each planIn this instance Delta Dental is the secondary policyA review of this members dental claims history indicates a claim submitted on behalf of the Oscar Flores for services performed on the date of service 1/13/The claim was received by Delta Dental on 8/30/and Explanation of Benefits was issued to the member and the dental office that stated the claim should be submitted to the primary insurance and then re submitted to Delta Dental so that we may issue a secondary benefitOur records further indicate that Ms*** contracted Delta dental and indicated that the primary policy is is not in effect and was advised by our customer service rep to provide the effective and termination date of the primary policyTo date, Delta dental has yet to receive the requested information and unfortunately we cannot adjudicate the claim without the primary insurance information notice of termination of the primary policyIt is my hope that this letter has addressed the inquiry of The Revdex.com on behalf of Ms***

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ***
I just want the refund, I have tried to get it back for months and they never get back to meI want Delta Dental to let the Revdex.com know that they are returning my payment for services not used.
Regards,
*** ***

I was never informed of the deductible and considering this was my third visit, one would assume the deductible had been met. I was informed this charge would be paid, not that it would applied to any deductible. 
Regards,
[redacted]

Delta Dental of Massachusetts has provided a written response to Mr. [redacted] on November 20, 2017.

Delta dental of Massachusetts is in receipt of the inquiry from  the Revdex.com on behalf of our member. As the administrator of dental benefits we are committed to the privacy and security of patient health information. Based on the information provided by the Better Business...

Bureau we will investigate the concerns of our member and contact them directly regarding the outcome.

Delta Dental of Massachusetts is in receipt of your inquiry regarding Ms. [redacted]. Delta Dental of Massachusetts is limited to a general review mostly related to the participating agreement with the dentist that encompasses the accurate submission of claims for completed services, general...

quality of care and the proper collection of the co-payment that is based on the participating provider's agreement with Delta Dental and the member's benefit plan. As the administrator of the dental benefits we are careful not to dictate treatment , instead we pay benefits, if applicable, based on services rendered as agreed upon between the dentist and the patient. Our records indicate that date of service for this claim is July 13, 2015, the claim was received by Delta Dental on August 15, 2015 and an Explanation of Benefits was issued on August 18, 2015. As noted on the Explanation of benefits issued to a member, Delta Dental will review appeals however; the request must bt received by Delta Dental within 180 days from the date of the original decision. unfortunately, when the allowed time frame has expired the appeal is forfeited.

As the      As the administrator of dental benefits Delta Dental of Massachusetts is committed to the privacy and security of our members personal health information. As such, we will respond directly to our member regarding their complaint....

             will

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted].
I did not receive a response from Delta Dental on 11/20 and haven't yet thus I don't have anything to respond to .
Regards,
[redacted]

Delta Dental of Massachusetts has provided a response to the subscriber via U.S. Mail regarding the check number of the refund that issued.

Delta dental offers residents of Massachusetts the option to purchase individual or family coverage independently. We partner with [redacted], a third party vendor who manages the application and payment of premiums. Delta Dental administers the dental benefits according to the plan design and...

provides customers service regarding benefit information and adjudications of claims. Our records indicate that Mr. [redacted] became effective with Delta Dental as of 12/01/10 and the membership has termed as of 3/31/2015. We have contacted [redacted], a third party vendor who manages the application and payment of premiums. Delta Dental administers the dental benefits according to plan design and provides customer services regarding benefit information and the adjudication of claims. Our records indicate that Mr. [redacted] became effective with Delta Dental as of 12/01/10 and the membership has termed as of 3/31/2015. We have contacted [redacted] on behalf of Mr. [redacted] and they have informed us that the premium had increased in December 2014 from 55.92 to 57.18. [redacted] sent a 30 day notice to a 60 day notice to the current address on file indicating the new premium as well as the intent to terminate the policy due to payments not received in full. Mr. [redacted] states that he submitted a change of address with the local post office and while we cannot confirm or deny this statement, we can confirm that [redacted] benefits states to this date, they have not received a change of address notice from Me. [redacted]. In summary, [redacted] benefits terminated the policy due to nonpayment of increased premiums and upon termination Delta Dental has upheld the terms of the application which include after cancellation there is a one year waiting period before re enrollment.

This response is inaccurate with the occurrence of my claims.  All claims have been submitted since early 2014 until the latest one of August 2015.  I have personally called several times and have spoken to 2 representatives including a voicemail message that I was asked to leave, providing a start and ending date of my previous policy with Assurant of 1/1/2014.  Currently, I am still paying to a company who refuses to process and ultimately pay for what they are responsible for.   Delta Dental refuses to honor service and customer service resolution.  Again, I expect a resolution to my claim.
Regards,
[redacted]

Delta Dental of Massachusetts is in receipt of your inquiry regarding Ms. [redacted]. Delta Dental of Mass is limited to a general review mostly related to the participating agreement with the dentist that encompasses the accurate submission of claims for completed services, general quality of...

care and the proper collection of the co payment that is based on the participating provider's agreement with Delta Dental  and the member's benefit plan. As the administrator of the dental benefits we are careful not to dictate treatment, instead we pay benefits. if applicable, based on services rendered as agreed upon between the dentist and the patient. A review of Ms. [redacted]'s claim history indicates a claim submitted on her behalf by [redacted],  the procedure was for a restorative filling on tooth #31 on the date of service 12/15/14. The submitted charge for this procedure was 163.00 and the contracted allowance is 82.00. In our agreement with Ms. [redacted]'s employer, this dental plan has an annual deductible of 100.00, $82.00 was applied to this claim, however because the deductible has not yet been satisfied; the member is responsible for the submitted charge of $163.00. A review of our internal communications indicates that Ms. [redacted] inquired via email to Delta Dental regarding this claim and was informed on 2/12/2015 that she had not yet reached her deductible and was responsible for the charge. Delta Dental confirms this claim was processed in accordance to our agreement with Ms. [redacted]'s employer. Should she dispute the applicable $100 deductible she should seek clarification regarding the terms of her dental coverage and her employer. It is my that this letter has addressed the inquiry of the Revdex.com on behalf of Ms. [redacted].

The bottom line is the company didn't make a truly hard attempt in notifying me about the increased premium per month (which was an increase of less than $2 per month), but they did find an active address to send my coverage cancellation letter.  Is this the type of customer service we deserve?  I don't think so.  I would like to speak with a higher supervisor in the Delta Dental company instead of a customer service rep.  I've been a paying member for 5 years and to have my coverage cancelled for not paying a premium increase of less than $2 per month is not right, and to say it was my responsibility to ensure my mailing address was updated thus leading to this cancellation.  Things happen beyond our control but we still ensure we do the right thing when taking care of people.  This cancellation is wrong. I would like to speak with a higher supervisor in the Delta Dental company.  I will also be contacting the Mass Consumer Affairs and Business Regulation, Division of Insurance about this situation.    
Regards,
[redacted]