Delta Dental of Minnesota

Initial Business Response /* (1000, 5, 2016/02/08) */
Delta Dental of Nebraska has thoroughly investigated this matter and submits the following response. The complainant has an individual dental insurance policy purchased through the Nebraska exchange. The policy is administered by Delta Dental...

of Nebraska; however, because the complainant purchased the policy through the exchange, he was required to cancel it through the exchange. The complainant did not cancel his policy until February 2, 2016, so Delta Dental correctly billed him for coverage through February 2016. Delta Dental has confirmed that the complainant's policy will be terminated as of February 29, 2016 and the complainant will not receive a bill for the March 2016 premium amount.

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.

Delta Dental of Minnesota (“Delta Dental”) has thoroughly investigated this matter and submits the following response.  The complainant is enrolled in Delta Dental’s Comprehensive Enhanced Plan, which Delta Dental administers on behalf of complainant’s employer.  On April 9, 2018,...

complainant had a comprehensive evaluation, prophylaxis and bitewing x-rays taken.  On April 11, 2018, complainant’s provider submitted a claim to Delta Dental for those services.  On April 13, 2018, Delta Dental sent complainant an Explanation of Benefits reflecting Delta Dental’s payment for the comprehensive evaluation and prophylaxis and denying the bitewing x-rays due to a frequency limitation.  According to the terms of complainant’s plan, complainant is allowed to receive bitewing x-rays once every 12 months.  Complainant had bitewing x-rays taken on May 25, 2017, and thus complainant was not eligible to receive bitewing x-rays until May 25, 2018.  Accordingly, Delta Dental has correctly denied the claim for bitewing x-rays taken April 9, 2018, in accordance with the terms of complainant’s plan.  If complainant still has concerns regarding Delta Dental’s processing of this claim, complainant may submit a written appeal in accordance with the terms of his plan documents. Additionally, complainant is entitled to see any provider of complainant’s choice.  Delta Dental does not require complainant to see a Delta Dental PPO or Premier provider in order to receive benefits under complainant’s plan.  Therefore, there is no correlation between complainant’s choice of provider and Delta Dental’s denial of complainant’s claim for bitewing x-rays.          In the future, Delta Dental encourages complainant to submit a pretreatment estimate or call customer service if there are any questions about potential member responsibility for services.

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 $1500 for her son’s orthodontic care, payable in an initial $750 payment at banding, and a second payment after six months so long as the complainant maintained continuous coverage. Delta Dental paid the initial $750 payment after receiving the complainant’s claim based on her son’s banding date of January 28, 2015.  When the complainant left her position, she chose to enroll her son into cobra coverage, effective April 1, 2015.  The cobra coverage was terminated effective July 31, 2015.  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 $125 based on the complainant’s termination date of July 31, 2015.  However, because the complainant had continuous coverage through the July 28, 2015 date of service, she should have received the full $750 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 /* (1000, 10, 2015/06/01) */
The complainant received dental treatment on January 15 and 27 at an out-of-network dentist. As a result, Delta Dental paid the patient directly rather than payment going to the dentist. The original check was issued in early February and...

sent to the address on file, but was not cashed. In April, the complaint contacted Delta Dental regarding payment. Delta Dental stopped payment on the first check and sent a second check to the address on file. In May, the complaint contacted Delta Dental again. At this time, Delta Dental determined that the address on file for the payment was incorrect and payment was re-processed for the complainant. On 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 correction. The complainant should have received full payment by now. Delta Dental expresses its apologies for the mix-up and the resulting delays.
Initial Consumer Rebuttal /* (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 1. Delta Dental made repeated accusations that 'the check is in the mail' right down to the last day of May 28 when the check was finally postmarked. The delays from Delta Dental ended up costing me more than the full reimbursement since I had to 'pull money' from paying bills for 4 months. Their disregard for rectifying the situation sooner than they did was unprofessional. After 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 insurance. Friends, co-workers & family will also be made aware of their business practices.

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, which Delta Dental administers on behalf of complainant’s employer.  On April 6, 2017, complainant’s provider...

submitted a claim for comprehensive orthodontia.  Then on July 19, 2017, the provider submitted a second claim for limited orthodontia.  Delta Dental denied the initial claim because the provider did not submit enough information to process the claim.  Delta Dental denied the second claim because it was determined that complainant received prior orthodontia treatment in 2007, and under the terms of complainant’s plan, orthodontia is not covered for retreatment or additional treatment necessary to correct or relieve the result of treatment previously covered under Delta Dental coverage.  On October 9, 2017, complainant appealed the denial of the claim.  On October 17, 2017 and October 27, 2017, Delta Dental informed complainant that the provider submitted two claims for orthodontia services using different procedure codes for the same date of service.  Delta Dental told complainant in order to further review the case, Delta Dental needed complete chart notes from the provider and additional information on the type of orthodontic treatment provided in 2007.  On January 3, 2018, complainant submitted additional information regarding complainant’s 2007 orthodontic treatment.  In addition, the provider submitted additional information clarifying the discrepancy between the procedure codes submitted for the same dates of service.  Delta Dental has reviewed the additional information and has decided to reprocess complainant’s claim to benefit in accordance with the terms of complainant’s plan.  Complainant and complainant’s provider will receive updated Explanation of Benefits reflecting the new payment amount.  Delta Dental regrets any inconvenience this may have caused complainant.

Initial Business Response /* (1000, 5, 2015/11/23) */
Delta Dental of Minnesota has reviewed this file carefully and submits the following response. The complainant sought payment for treatment beginning in July 2014. According to the terms of the complainant's plan for the treatment received,...

Delta Dental must have proof of any prior payments or payment denials from the complainant's provider before making any payments on the claim. Delta Dental experienced a delay in receiving this information from the complainant's provider, but has since obtained the correct information. The claim has been processed and paid according to the terms of the complainant's policy. Delta Dental regrets any confusion or delay this has caused.

Delta Dental of Minnesota (Delta Dental) has thoroughly investigated this matter and submits the following response.  Complainant has secondary insurance through Delta Dental as a dependent on her spouse’s plan.  Complainant had dental services performed in December 2016 and sought...

reimbursement from Delta Dental.  Delta Dental initially denied the claim for these services because the claim amount submitted to Delta Dental was higher than the claim amount submitted to her primary insurer.  Delta Dental then worked with the complainant and her provider to obtain a corrected claim.  On April 27, 2017, Delta Dental received the corrected claim from the complainant’s provider and reprocessed the claim on May 2, 2017 to provide benefits.  Delta Dental issued a check to complainant’s provider on May 9, 2017.

Initial Business Response /* (1000, 8, 2016/02/01) */
Delta Dental of Minnesota has thoroughly researched this matter and submits the following response. Complainant had an individual dental insurance policy for which she paid premiums quarterly. Complainant called Delta Dental to cancel her...

dental insurance policy effective immediately. Delta Dental responded that the policy would be cancelled effective November 30, 2015. Unfortunately, the cancellation was submitted after the scheduled premium withdrawal for the next quarter (December 10, 2015). Delta Dental has now processed the refund request and provided the complainant her refund for the quarter running from December 2015 - February 2016. Delta Dental regrets any inconvenience this has caused.
Initial Consumer Rebuttal /* (2000, 10, 2016/02/10) */

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.

I am rejecting this response because: this is not what occurred in the least! The claim was rejected because they are the secondary and they were unaware that the primary had been billed and denied the claim due to the fact that the procedure was not covered. When I spoke to Mindy on 3/10 at 10:40am after discovering that the claim to Delta MN had been denied she took verbal notes from me and said that I did not need to send her the EOB from Delta CA. It was only when I spoke to Mike V on the morning of 4/10 that he discovered the mistake that Mindy had made in not requesting the EOB denial. He asked that be sent to his attention, it was. THAT is when he discovered that there were two different charges to Delta CA and Delta MN. Mike V promised that after speaking to his supervisor this situation was going to be rectified expeditiously. It was not, it took repeated phone calls from me, different reps requesting that I refax documents to them that had already been sent to previous reps and the insurance coordinator for my dental office refaxing the same document over and over. Customer service from the supervisors of the phone staff is subpar to say the least. I find it repugnant and reprehensible that Delta MN is flagrantly attempting to gloss over their ineptness and make it seem like they attempted to assist me when that is not what happened at all. This situation was resolved due to my persistence and had nothing to do with any staff member at Delta MN making it their business to assist me, the customer. DO BETTER DELTAMN!!!

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, 2016.  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 forward. Complainant 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.

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

Initial Business Response /* (1000, 5, 2015/06/29) */
The name and address are not coming up with any information on a current subscriber. We will need a date of birth, subscriber ID number and/or a social security number to identify the complainant.
Initial Consumer Rebuttal /* (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 account. He informed me that he will reply via this process.
Final Consumer Response /* (3000, 16, 2015/08/03) */
I have contacted the Delta Dental some time ago and given Mr. Laly 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 /* (4000, 18, 2015/08/12) */
Initially, the consumer's inquiry did not have enough information to identify the specific account. After 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 account. The consumer had a different understanding as to when these monthly withdrawals would occur. Delta Dental has now canceled the policy at the consumer's request. Premiums paid will be refunded along with overdraft charges. Delta 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 two dental insurance policies, one through his employer (“primary plan”) and one through his ex-spouse’s employer (“secondary plan”).  The...

complainant has a $2000 maximum annual benefit under his primary plan.  Additionally, the complainant has a $2000 maximum annual benefit under his secondary plan only for covered services provided by Delta Dental PPO dentists.  Under the secondary plan the annual maximum is $1000 for covered benefits provided by Delta Dental Premier or Out of Network dentists. At the time the complainant received his night guard, complainant had already exhausted his $2000 annual maximum benefit on his primary plan.  On his secondary plan, he had already used $1525.95 in covered benefits provided a PPO dentist.  Thus, the complainant had $404.75 left in secondary plan for covered benefits provided by PPO dentists, and complainant had $0 left for covered benefits provided by Premier and Out of Network dentists. The dentist who provided complainant the night guard was not a PPO provider; he is a Premier provider.  Thus, because the complainant had already reached his annual maximum for covered benefits provided by Premier and Out of Network dentists ($1000), Delta Dental correctly denied the complainant’s claim.