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Delta Dental of New Jersey, Inc.

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Delta Dental of New Jersey, Inc. Reviews (1)

Review: My Group ID # is [redacted] for claim [redacted] through [redacted] Schools. I recently had three cavities filled on May 30, 2013 by Dr[redacted] I was given an estimate two months prior for these services. The dental office printed off a treatment plan description for me with out of pocket costs estimated at a total of $148.25. Before I went in for these services, I called Delta Dental to verify this estimate. The male representative I spoke with on the phone that week explained my plan to me and told me the estimate was accurate. After these services were performed and I fulfilled my out of pocket patient obligation, I am now being told that I owe an additional $102.00. I called Delta Dental this morning (6/24/13) and the representative told me that the only way insurance can verify out of pocket patient obligations is through a formal submittal of the treatment estimate, which takes 4-6 weeks for approval. This is not what I was told last month when I spoke with the other Delta Dental representative. If I had known about this procedure, I would have submitted my paperwork in advance for approval. Their customer service rep never made me aware of being able to send in the estimate to get confirmation and only gave me a verbal confirmation. However, since I was given an estimate from my dental office and had that estimated reviewed by an insurance representative over the phone, I do not feel that I should have to pay an additional amount of $102.00. Simply stated, you cannot tell a client that a procedure will cost $148.25 out of pocket and allow them to have those services rendered, only to recant that statement weeks later with a new patient obligation. I refuse to pay this additional amount because I spoke to someone at Delta Dental that did not fully understand their own company policies and did not give me the proper channels to get my estimate properly verified.Desired Settlement: Delta Dental must pay the amount they confirmed to me prior to my visit to my dentist and I am not paying an additional $102.

Business

Response:

I apologize for the delay in our response. As described in my voicemail to you, we had to have the call reviewed and the request for an allowance outside of the group contract reviewed.

The discussion between Mrs. [redacted] and our Customer Service Agent consisted of composite (white) fillings, and the alternate benefit of an amalgam filling if performed on posterior teeth. Mrs. [redacted] said that the dental office had told her $150 and our Agent said that that sounds pretty accurate – could be more, could be less.

There was also a discussion about the differences between a PPO Dentist (her former Dentist) and the current Dentist who is only Premier. It was explained that the fees are about 30% less.

While we feel that accurate information was provided, we do feel that our Agent could have been clearer. We have, therefore, made an adjustment to claim [redacted] in the amount of $102. This adjustment will reduce the patient responsibility for date of service 5/30/13 from $250.25 to $148.25.

We hope that Mrs. [redacted] understands her benefits better now. But please let her know that if she has any questions going forward, please call us or request a Pre-Treatment Estimate.

Please let us know if you have any further questions.

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

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

Regards,

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Description: Insurance - Dental, Dental Service Plans

Address: 1639 Route 10, Parsippany, New Jersey, United States, 07054

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