Delta Dental Of Virginia

Delta Dental of Virginia is in receipt of a recent complaint for the above individual identified under IDnumber [redacted] .The coverage for this individual is through an Administrative Services Only policy with the employer.Delta Dental of Virginia suggests that the individual work with the group administrator concerningthis complaint.Sincerely, [redacted] ***Corporate Compliance Analyst

I have reviewed the response offer made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below Attached please find the comparison sheet they provide to enable you to make a choiceThe representative never mentions to check the actual policy as the comparison is not totally representative of actual coverage Additionally the other two plans on the sheet QUALIFY the cover but do not when it applies to their Clear PlanIf I would have known it represented only one crown per year, you can at least make a informed decision Finally when you buy the plan, you are not told to review the Contract Language as it specifies the actual benefits which may differ then the Get A Quote comparison plan sheet They use the word Crowns, Implants all plural meaning more than oneThe sheet is a clear example of disinformation and advertisement [redacted]

I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me I will wait for the business to perform this action and, if it does, will consider this complaint resolved Regards, [redacted] ***

This letter is in response to the complaint submitted to Delta Dental of VirginiaPlease be advised thatthe policyholder has Individual Clear coverage administered by Delta Dental of WisconsinThefollowing is their response to the complaint.The member enrolled over the telephone so the member does not attest to having read the policydocumentsThose enrolling via telephone receive ID cards and a welcome letter that includesinstructions on how to access their policy via deltadentalcoversme.com or they may elect to return theenclosed post card for a paper policy.Attached is a copy of the Clear Plan summary of benefits, Welcome Letter, and Schedule of DentalBenefits, Limitations and Fixed Patient CopaymentsPlease note under Restorative Dental Proceduresthe policy indicates the fixed copayment for a crown is $and "Only one crown for each coveredperson every months."Please contact me if you have any additional questions at ###-###-####Respectfully, [redacted] ***Corporate Compliance Analyst

Thank you for forwarding the rebuttal request regarding complaint ID *** to our attention.Delta Dental of Virginia appreciates the feedback from our policyholder regarding the reference tocrowns and implants as plural in our Clear Policy.The policyholder was provided with an opportunity to receive a printed copy of his dental benefitpolicy over the phone or by returning a post cardAdditional, all policy holders enrolling over thetelephone are directed to the website to print a copy of the policy and to carefully review it.In the first paragraph of the Clear Policy it it states: Please read this entire Policy carefully so you willbe aware of its Benefits, limitations and other terms and conditionsListed Under the sectionSchedule of Dental Benefits, Limitations and Fixed Patient Copayments the Clear Policy statesOnly one crown for each covered person every months.With regard to implant services, the Clear Policy states *Surgical placement of implant body (includesimplant, crown and abutment); one-(l) implant per site up to a maximum of two-(2) implant bodies perquadrant of the mouth per lifetime.DDVA upholds our position that we provided the policyholder with appropriate language in the ClearPolicy and an opportunity to cancel the policy within the first ten (10) days.In closing, if the policyholder is still dissatisfied with our determination, DDVA recommends he bereferred to the Office of Managed Care Ombudsman for further assistance.Address: Office of Managed Care OmbudsmanVirginia Bureau of Insurance** *** *** ** ***Telephone Toll-Free: ###-###-#### Richmond ###-###-#### E-Mail: ***Web Page; ***Please contact me if yuo have any additional questions at ###-###-####.Respectfully,*** ** ***Director, Legal and Compliance

This letter is in response to the complaint submitted to Delta Dental of Virginia (DDVA) Please be advised that the policyholder has coverage through his employer, *** ***, a fully-insured Delta Dental PPO+ contract effective January 1, 2014.Attached is a copy of the subscriber's Evidence
of Coverage booklet that explains How to Estimate Your Costs (Delta Dental PPO (Plus Premier) Plans, Predetermination of Benefits, Schedule of Benefits that explains the dental procedures and coverage levels for participating and non-participating providers.The subscriber's claim history reflects dental treatment performed by three (3) different dentists For the service dated March 9, and January 8, 2015, the subscriber saw a non-participating provider The services dated April 9, were performed by a participating provider.On April 24, 2015, the subscriber spoke to one of our Benefits Services supervisors after his previous phone calls regarding his benefits were reviewed The supervisor determined that no one gave the subscriber the wrong benefits and DDVA will not pay any additional monies for his claims.Please contact me if you have any additional questions at ###-###-####.Respectfully,*** ** ***Corporate Compliance Analyst

This letter is in response to the complaint submitted to Delta Dental of VirginiaPlease be advised thatthe policyholder has Individual Clear coverage administered by Delta Dental of WisconsinThefollowing is their response to the complaint.Subscriber’s request to terminate coverage due to loss of
employment was received on 02/19/andprocessed on 02/20/Per the contract, loss of employment is not a qualifying event to terminatecoverage mid-contract.The policy was terminated for the end of the contract, 11/30/15, and notice of termination was mailedto the subscriber on 02/20/15.Please contact me if you have any additional questions at ###-###-####.Respectfully,*** ** ***Corporate Compliance Analyst

I have reviewed the response offer made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.I have provided them with adequate information of why the claim should be coveredThey are unable to give me a valid response when I called there customer service. Review the documentation and explain what exclusions are listedNoneRegards,*** ***

This letter is in response to a customer complaint submitted to the Revdex.com (Revdex.com) by
*** ***
Delta Dental of Virginia will respond directly to Ms*** as an authorization from her to release
protected health information was not submitted with your inquiry
Please
contact me if you have any questions at ###-###-####
Respectfully,
*** *. ***
Director, Legal and Compliance

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Attached please find the comparison sheet they provide to enable you to make a choice. The representative never mentions to check the actual policy as the comparison is not totally representative of actual coverage.
Additionally the other two plans on the sheet QUALIFY the cover but do not when it applies to their Clear Plan. If I would have known it represented only one crown per year, you can at least make a informed decision.
Finally when you buy the plan, you are not told to review the Contract Language as it specifies the actual benefits which may differ then the Get A Quote comparison plan sheet.
They use the word Crowns, Implants all plural meaning more than one. The sheet is a clear example of disinformation and false advertisement.
[redacted]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

This letter is in response to the complaint submitted to Delta Dental of Virginia (DDVA) via email on January20, 2016 for ID#[redacted].The subscriber’s appeal has been overturned. His claim for the crown and buildup will be processed within thenext 7-10 business days.Please contact me if you have any additional questions at [redacted].Respectfully,[redacted]Product Filing Analyst

Delta Dental of Virginia is in receipt of a recent complaint for the above individual identified under IDnumber [redacted].The coverage for this individual is through an Administrative Services Only policy with the employer.Delta Dental of Virginia suggests that the individual work with the group...

administrator concerningthis complaint.Sincerely,[redacted]Corporate Compliance Analyst

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.Regards,[redacted]

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Basically I am not satisfied as the operator that I spoke to never told me I had 10 days to read the policy because there were restrictions to the published comparison sheet and especially for the Clear Choice.
Additionally, could you provide a transcript of our conversation upon which I made my purchase. I ask because I mentioned that the Clear Plan appeared excellent as it spelled out all the cost's for each procedure. There was no mention to read the policy before signing up for this program. Additionally she indicated it was an excellent policy. However, if you can get the transcript, it would most appreciated as I totally didn't hear what she was saying or she didn't tell me sufficient information to provide a informed decision.
I referred to the comparison sheet a couple of times and was not corrected or directed to read the policy. I was told to sign the contract and return it!
Sincerely, [redacted]

Delta Dental of Virginia  is in receipt of a recent complaint for the above individual identified under ID number [redacted]The coverage for this individual is through an Administrative Services Only policy with the employer.  Delta Dental of Virginia suggests that the individual work with...

the group administrator concerning this complaint.Sincerely,[redacted]Product Filing Analyst

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Attached, please find my 2 EOBs that is the evidence of
Delta Dental having charged me twice the $50.00 deductible.
 
Regards,
[redacted]

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]

This letter is in response to the complaint submitted to Delta Dental of Virginia. Please be advised thatthe policyholder has coverage with an individual plan that is administered by Delta Dental ofWisconsin. The following is their response to the complaint.On December 26, 2014, the policyholder...

contacted Customer Support requesting a stop on the EFTtransaction with her bank. We were unable to stop the transaction as the file was already sent throughthe Federal Reserve to the bank. To stop an EFT transaction, Delta Dental would need notification bythe 24th of the month to change payment method. At this time we cannot stop the transaction.On December 27, 2014, an attempt was made to draw $23.00 from the policyholder account forJanuary premium. A rejection from the bank was received on December 29, 2014 due to non-sufficientfunds.On January 23, 2015, the policyholder called and advised she does not have funds to pay for thepremiums and requested we not draw the premium due. The policyholder requested other options forpayment. We advised we also accept credit card payment. The policyholder said she does not have acredit card. She said she does not want the coverage terminated but is unemployed. We advised thatwe will attempt to draw again on January 27 and if the funds are not available the coverage wouldterm.On January 27, 2015, we attempted to draw $46.00 from the members account for January andFebruary premium. We received a rejection from the bank on January 30, 2015 due to non-sufficientfunds. The plan was then terminated due to nonpayment on January 31, 2015.Delta Dental processed and paid a claim for a January 27, 2015 date of service with a total payment of$100.10.Please contact me if you have any additional questions at ###-###-####.Respectfully,[redacted]Corporate Compliance AnalystDelta Dental of Virginia

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
The wording of the response from Delta Dental is extremely ambiguous ('The subscriber’s appeal has been overturned. His claim for the crown and buildup will be processed within thenext 7-10 business days') and does not clarify is the claim will actually be 'approved' or 'paid'.  We are asking that Delta Dental provide clarification.
Regards,
[redacted] [redacted]