Delta Dental of Minnesota

In Oct, 2019 I suffered several severe orthopedic injuries that required surgery. While awaiting surgery (2+ months) I was in constant tooth grinding pain. The grinding eroded significant portions of my front teeth, top and bottom, to the point where my dentist insisted I get crowns while there still remained enough tooth to anchor to. Pre-authorization was requested and originally granted to repair the damaged teeth(12 of them). After work was started, Delta then denied the claim, claiming that the work was cosmetic. We appealed the claim. In denying the appeal, Delta stated that the work would only be covered in the event of things like fracture or erosion. My dentist then re-appealed and sent the original 20 plus photos, the X-rays, and copies the original impressions. The denial sent to him stated that Delta would pay because they don't cover things live fracture, abrasion, or erosion. I am at the point where I will contact an attorney and seek punitive damages(because this has become a clear cut case of a "Bad Faith Claim", and as such, punitive damages now can apply. I also intend to provide all of my records to the plaintiff attorneys in several federal class action lawsuits. Delta Dental can try to parse and spin what they've done to me, but it's only rhetoric. I'll let a jury decide what the truth is. All I want is the $3300 benefit Delta is obligated to pay. It's hard to see why a giant like delta will spend tens of thousands of dollars fighting a $3300 claim and expose themselves by going through the discovery and deposition process, but I'm sure they'll try.

Delta Dental of Minnesota (Delta Dental) has thoroughly investigated this matter and submits the following response In December 2015, complainant enrolled in a Delta Dental family dental plan through MNsure with an effective date of January 1, However, Delta Dental of Minnesota did not receive the electronic enrollment file from MNSure After investigating the matter, Delta Dental has enrolled the complainant and her dependents in the dental plan she selected in December Her coverage is effective immediately, and complainant will only be charged for premiums moving forwardComplainant will be receiving new subscriber ID cards in the mail shortly Before she receives the cards, complainant may receive dental services from her provider and have her provider call Delta Dental to confirm her enrollment Delta Dental regrets any inconvenience this has caused

Delta Dental of Minnesota cannot find a subscriber by the name of [redacted] If Ms [redacted] could please provide her subscriber ID number, Delta Dental will be happy to respond to this complaint.Thank you

Revdex.com:My subscriber number is [redacted] It is through my wife's employer, Target-Enhanced Dental Her name is [redacted]

Initial Business Response / [redacted] (1000, 10, 2015/06/01) */ The complainant received dental treatment on January and at an out-of-network dentistAs a result, Delta Dental paid the patient directly rather than payment going to the dentistThe original check was issued in early February and sent to the address on file, but was not cashedIn April, the complaint contacted Delta Dental regarding paymentDelta Dental stopped payment on the first check and sent a second check to the address on fileIn May, the complaint contacted Delta Dental againAt this time, Delta Dental determined that the address on file for the payment was incorrect and payment was re-processed for the complainantOn or about May 26, Delta Dental sent a check was to the correct address and the internal system at Delta Dental was updated to reflect this correctionThe complainant should have received full payment by nowDelta Dental expresses its apologies for the mand the resulting delays Initial Consumer Rebuttal / [redacted] (2000, 12, 2015/06/02) */ (The consumer indicated he/she ACCEPTED the response from the business.) Payment for services performed in Janurary were finally received June Delta Dental made repeated accusations that 'the check is in the mail' right down to the last day of May when the check was finally postmarkedThe delays from Delta Dental ended up costing me more than the full reimbursement since I had to 'pull money' from paying bills for monthsTheir disregard for rectifying the situation sooner than they did was unprofessionalAfter they found their errors I expected the check to at least be tracked if not submitted express but they simply mailed it for a third time standard post I plan to re-evaluate my current & future business with Delta and will most likely look elsewhere for dental insuranceFriends, co-workers & family will also be made aware of their business practices

I am rejecting this response because: I am surprised of the lack of care Delta Dental has for its customersI did not want to switch dentist but was forced to because of extremely low caliber of dentist recommended by Delta DentalI had a bite wing done in May of and now one in April of Yes I had it done in months instead of but I was forced to get a new dentist since the last one did not show up for my appointmentI will not have another bite wing done until 2019, so I feel as if Delta is making me pay for the only one I am getting this year and I feel it is not fairEspecially since their last recommended dentist did not do his job and I have no choice but to find a new dentistDelta Dental should realize that sometimes things come up and that they are losing no money by paying for my bite wing examIn fact I am not getting what I am paying for with my monthly insurance payments if I have to pay this myselfIt seems that this company would be willing to work with me since they have had my business for over years now

Delta Dental of Minnesota (Delta Dental) has thoroughly investigated this matter and submits the following response The complainant was enrolled in a dental insurance policy through her employer, [redacted] Under the terms of the plan, the complainant would receive a lifetime maximum of $for her son’s orthodontic care, payable in an initial $payment at banding, and a second payment after six months so long as the complainant maintained continuous coverageDelta Dental paid the initial $payment after receiving the complainant’s claim based on her son’s banding date of January 28, When the complainant left her position, she chose to enroll her son into cobra coverage, effective April 1, The cobra coverage was terminated effective July 31, The complainant then submitted a claim for payment with a date of service of July 28, 2015, and Delta Dental paid a prorated amount of $based on the complainant’s termination date of July 31, However, because the complainant had continuous coverage through the July 28, date of service, she should have received the full $payment, not the prorated amount Delta Dental has reprocessed the complainant’s claim to pay the additional $625, and her provider should receive a check within a month

Initial Business Response / [redacted] (1000, 5, 2015/06/29) */ The name and address are not coming up with any information on a current subscriberWe will need a date of birth, subscriber ID number and/or a social security number to identify the complainant Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/07/09) */ (The consumer indicated he/she DID NOT accept the response from the business.) I called Mr [redacted] and responded to his request for more personal information to identify my accountHe informed me that he will reply via this process Final Consumer Response / [redacted] (3000, 16, 2015/08/03) */ I have contacted the Delta Dental some time ago and given MrLaly all the personal information he needed to access my Delta Dental account - but I am still being billed for August when I canceled my plan in June....this August billing caused another overdraft in my account The company has not responded to his complaint - what's the hold up? what's the next step in this failing processing? Final Business Response / [redacted] (4000, 18, 2015/08/12) */ Initially, the consumer's inquiry did not have enough information to identify the specific accountAfter obtaining the account information, Delta Dental identified the account and confirmed that the consumer's initial payment preference was to have automatic withdrawals from his bank accountThe consumer had a different understanding as to when these monthly withdrawals would occurDelta Dental has now canceled the policy at the consumer's requestPremiums paid will be refunded along with overdraft chargesDelta Dental apologizes to the consumer for the misunderstanding about when automatic premium withdrawals would occur

Delta Dental of Minnesota (Delta Dental) has thoroughly investigated this matter and submits the following response. The complainant is enrolled in a Delta Dental PPO Plan through his employer. Under the terms of the plan, the complainant is required to see an in-network Delta Dental PPO
provider in order to receive benefitsComplainant received dental services from a provider who is not in the Delta Dental PPO network, and Delta Dental denied the claimHowever, because there may have been some confusion regarding the network information provided by Delta Dental, Delta Dental has reprocessed complainant’s claim to provide benefits. In the future, complainant must see an in-network Delta Dental PPO provider in order to receive benefitsDelta Dental regrets any inconvenience this may have caused complainant

Delta Dental of Minnesota (Delta Dental) has thoroughly investigated this matter and submits the following response. The complainant’s husband (the “complainant”) is enrolled in a dental insurance policy through his employerDelta Dental administers the plan on behalf of complainant’s
employerUnder the terms of the plan, the plan would reimburse the complainant percent of the allowable fee for qualifying orthodontic care up to a lifetime maximum of $2,000, payable in two installments. The first payment is payable at the time of banding, and the second payment is payable after six months. Among other things, treatment must be prescribed by a dentist, orthodontist or oral surgeon to be qualifying careComplainant purchased invisible aligners from Smile Direct Club, an on-line store, for a total of $1,400. On December 30, 2016, Delta Dental paid the initial $payment after receiving complainant’s claim based on his banding date of August 29, 2016. On April 6, 2017, complainant filed a second claim to obtain reimbursement for the six month $installment payment. Delta Dental denied the second claim citing the services received were not a covered benefit under complainant’s plan. As a result of that determination, Delta Dental requested complainant repay the initial $payment. However, because complainant may have initially received inaccurate information from a Delta Dental customer service representative regarding his plan coverage, Delta Dental has reprocessed complainant’s second claim to provide benefits in the amount of $350, and is retracting the refund request made to complainant for the initial $payment. Delta Dental regrets the inconvenience that this has caused complainant

Initial Business Response /* (1000, 5, 2015/12/21) */
Delta Dental of Minnesota has reviewed this file carefully and submits the following responseThe complainant called Delta Dental customer service on December 7, seeking to cancel her dental insurance coverage effective November 30,
The cancellation was processed on December 11, Unfortunately, Delta Dental's automatic withdrawal system for premium payments was set to withdraw December premium payments on December 10, 2015, and erroneously withdrew the December premium amount from the complainant's bank accountDelta Dental began processing a refund for the December premium on December 11, The refund will take 7-business days to process, and the complainant should have her full refund by the end of December Delta Dental regrets any confusion this has caused
Initial Consumer Rebuttal /* (2000, 7, 2015/12/22) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I'm still waiting for my refund and either way, I am appalled at how this matter was handledNot once did anyone at delta dental apologize when I spoke to themTheir customer service skills are awful and no one I spoke to seemed to be on the same pageThey make you feel like it's your fault they made a mistake and speak to you like you're dumbThey need to work on their customer service skills
Final Business Response /* (4000, 22, 2016/02/02) */
Delta Dental of Minnesota apologizes for the delay in getting the complainant her refundDelta Dental just commenced a new refund review process, and the new process combined with the holidays resulted in a delay in having refunds processedThe requested refund has now been processed and provided to the complainant
Final Consumer Response /* (2000, 24, 2016/02/10) */

Delta Dental of Minnesota (“Delta Dental”) has reviewed complainant’s rejection of Delta Dental’s second response and submits the following additional response. After receiving complainant’s rejection, Delta Dental thoroughly researched complainant’s benefit file. To date, Delta Dental has no documentary evidence of any submission by complainant of a written appeal or related correspondence to Delta Dental regarding this matter other than those communications made through the Revdex.com. Complainant has provided no such evidence of a written appeal to dateIf complainant wishes to appeal Delta Dental’s denial of his claim, he must follow proper appeal procedures set forth in his benefit booklet. Specifically, Page of complainant’s benefit booklet clearly states: “In the event that we deny a claim in whole or in part, you have a right to a full and fair review. Your request to review a claim must be in writing and submitted within days from the claim denial. Your appeal must include your name, your identification number, group number, claim number, and dentist’s name as shown on the Explanation of Benefits. Send your appeal to: You may submit written comments, documents, or other information in support of your appeal.” As part of our further review of complainant’s benefit file, Delta Dental has again confirmed that his claim was correctly denied for the reasons already stated in prior responsesIn addition, it has become clear from our expanded review that complainant’s claim was also properly denied because occlusal guards are not a covered benefit under complainant’s applicable plan. This exclusion is detailed on page of complainant’s benefit booklet (“Coverage is NOT provided for occlusal procedures including occlusal guard…”)

Initial Business Response /* (1000, 7, 2016/02/19) */
Delta Dental of Minnesota has thoroughly investigated this matter and submits the following responseDelta Dental never received communication from the complainant requesting a cancellationHowever, based on the complainant's written
complaint to the Revdex.com, Delta Dental has now processed the cancellation effective December 31, and processed a refund for the January premiumDelta Dental regrets any inconvenience this may have caused complainant
Initial Consumer Rebuttal /* (2000, 9, 2016/02/22) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I will be satisfied with the refund(And the letter was sent to the address on the letterhead on which the rate notice was sentIf there is a preferred address for mail correspondence, perhaps that could be included on the letter.) Thank you

Delta Dental of Minnesota (“Delta Dental”) has thoroughly investigated this matter and submits the following response. On December 8, 2017, complainant purchased a Delta Dental Individual and Family Pediatric Dental High Plan and Adult Dental Silver Plan through MNsure. The plan became
effective January 1, 2018. Delta Dental has no record of any communication with complainant regarding complainant’s selection of this planOn January 15, complainant went on-line and paid his premium payment for January. After complainant made his first premium payment, he was officially enrolled in the plan, and was given access to his on-line account, including his benefits booklet. On January 15, 2018, complainant called Delta Dental for the first time, and stated he was enrolled in the incorrect plan and he wanted it corrected. Delta Dental informed complainant that, because complainant signed up for his plan through MNsure, he would have to contact MNsure to change and/or cancel his plan. On January 18, 2017, complainant sent Delta Dental an email requesting a refund of his January premium payment. Delta Dental immediately responded to complainant’s email and again informed complainant that he must contact MNsure to terminate his policy and request a refund. Complainant was further informed that if he cancelled his policy with MNsure, MNsure would send Delta Dental the appropriate information to terminate complainant’s policy and process a refund if appropriate. Delta Dental informed complainant that this process could take up to days. To date, Delta Dental has not received a cancellation notice from MNsure for complainant’s policy, nor has Delta Dental received any directive from MNsure to issue complainant a refund. Once Delta Dental receives notification from MNsure to cancel complainant’s policy and/or issue complainant a refund, Delta Dental will cancel complainant’s policy and, if directed by MNsure, issue complainant a refund

I am rejecting this response because: I reject the response of this business.  I deny the allegations made stating that I received earlier notification of the limitation in coverage that the business has referred to.  I deny the allegations made stating that I was told by customer service representatives of this business about the claims appeal process of this business.  As evidenced by the written correspondence of record on this Revdex.com complaint, and by the other written communications I have had with the business to date, I have already submitted an appeal to this business on this matter.  This matter remains outstanding and unresolved.  I reserve all rights and defenses pertaining hereto.  I intend to pursue this matter further through an alternative venue.[redacted]

Delta Dental of Minnesota (Delta Dental) has thoroughly investigated this matter and submits the following response.  The complainant was insured through Target’s dental insurance plan for which Delta Dental is the third party administrator.  Per the terms of Target’s plan, orthodontia...

payments are made in three installments: upon initial banding, 6 months after initial banding, and 12 months after initial banding.  The complainant’s daughter had her braces banded on April 29, 2015.  In accordance with the Target plan, the complainant was eligible for payments on April 29, 2015, October 29, 2015, and April 29, 2016.  Delta Dental made the first two payments.  However, the complainant’s policy with Target was terminated effective January 31, 2016, and the Target plan requires that covered persons must be enrolled in the plan in order to receive ongoing orthodontic payments.  Thus, the complainant was not eligible for the third payment on April 29, 2016.  Delta Dental does not make the decisions regarding benefits or coverage for the complainant’s plan – those decisions are made by the complainant’s employer.  Delta Dental encourages the complainant to check with his new employer to determine if he has any benefits available under the new plan.

I am rejecting this response because: I am surprised of the lack of care Delta Dental has for its customers. I did not want to switch dentist but was forced to because of extremely low caliber of dentist recommended by Delta Dental. I had a bite wing done in May of 2017 and now one in April of 2018. Yes I had it done in 11 months instead of 12 but I was forced to get a new dentist since the last one did not show up for my appointment. I will not have another bite wing done until 2019, so I feel as if Delta is making me pay for the only one I am getting this year and I feel it is not fair. Especially since their last recommended dentist did not do his job and I have no choice but to find a new dentist. Delta Dental should realize that sometimes things come up and that they are losing no money by paying for my 2018 bite wing exam. In fact I am not getting what I am paying for with my monthly insurance payments if I have to pay this myself. It seems that this company would be willing to work with me since they have had my business for over 10 years now.

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 me. Complaint [redacted]. I called Delta Dental yesterday after I called you for an update. They told me that a check was mailed...

on 5/6. I received it today. This is the result that I wanted. I accept the result but Delta Dental should put some effort into resolving the situation. Apparently it is widespread for refunds. Thanks for your effort.

Initial Business Response /* (1000, 7, 2015/11/04) */
Delta Dental of Minnesota has reviewed this file carefully and submits the following response. The complainant has coverage under a dental benefits plan that requires preauthorization for the procedure she needed. Complainant experienced...

difficulty finding an available provider due to location and timing concerns. The complainant found an available provider and submitted documentation for preauthorization on October 7, 2015. Normal processing of a preauthorization takes 4-6 weeks. However, due to complainant's concerns regarding availability of providers to complete the procedure and her experiencing significant pain, the preauthorization was expedited and processed in 4 business days. The complainant was able to have her procedure completed on October 13, 2015. Delta Dental of Minnesota apologizes for any confusion.

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 me.I want to say thank you so much for your assistance in this matter.  Your efforts led to a solution I was not able to get on my own, despite repeated efforts and help from my dentist - and for that I am very thankful.  I have copied my dentist office on this message.  Cheers,[redacted]