Delta Dental Plan of Missouri

Horrible insurance company! They sent us a check on 11/13 which was never received. We called twice, they said they stopped the payment on that check and would issue another one. 2 weeks later, still nothing. Very shady business. The company must be investigated for fraud!

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 Sincerely, [redacted]

Initial Business Response / [redacted] (1000, 5, 2015/12/04) */ Contact Name and Title: [redacted] SR VP & COO Contact Phone: XXX-XXX-XXXX Contact Email: [redacted] @deltadentalmo.com Dear Revdex.com, Ms [redacted] has filed a complaint regarding her Individual PolicyShe contacted us in September after receiving her renewal notice for November, which included an increase in premiumAt her request, we switched her to a lower cost plan as of 11/1/On November 24th, she contacted us stating she wanted the change made as of January We explained that policy changes are only made at time of renewalI have reviewed all recorded phone calls between our Delta Dental representatives and Ms [redacted] While I regret that this member's perception is that our people are rude, I did not get the same impression when listening to the call recordingsOn November 25th, Ms [redacted] called and notified us that she has put a stop on all future bank chargesWe have therefore processed a termination of this policy as of 12/31/2015, since her December premium had been paid on November 19th I have prepared a summary of all phone conversations between Ms [redacted] and Delta Dental representativesThis information will be faxed to the Revdex.com at XXX-XXX-XXXXCall information needs to remain confidential as it contains Personal Health Information protected by HIPAA Should you need any additional information or have questions, please do not hesitate to contact me Thanks, [redacted] Senior Vice President & COO [redacted] @deltadentalmo.com Phone XXX-XXX-XXXX Initial Consumer Rebuttal / [redacted] (3000, 8, 2015/12/04) */ (The consumer indicated he/she DID NOT accept the response from the business.) I was not properly informed that the date would not be jan and I did pay them to the end of the year and should have at least one payment coming backI also state that their people were extremely rude , I guess she's used to itI remain dissatisfied with Delta DentalThey act as though they are the only business for Dentistry and you are stuckThanks but no thanks when it come to them - I have found another BETTER plan immediately!

Dear Revdex.com,Our records show the following payments were mailed to Ms*** for dental services rendered on June 27, 2016:7/21/Check #*** for $(Not Received)7/28/Check #*** for $(Received)11/24/Check #*** for $(A reissue of the 7/21/check,
also not received)All of the above checks and Explanation of Benefits documents were mailed using the same postal name and addressAnother reissue of the $check is scheduled to be mailed in our next weekly claim payment run on February 2, However, due to the lengthy delay in our member receiving her payment, we are preparing a manual check which has been sent via overnight mail todayThis will be mailed with copies of the two previous checks that were mailed but not receivedWe hope this resolution is satisfactory to Ms*** and the Revdex.comShould you need any additional information, please do not hesitate to contact me.Sincerely,*** ***

Ms***'s complaint is a result of the denial of benefits for one of her fillings performed on 4/12/Apparently the dental office did not anticipate this denial, and originally collected what they estimated would be the patient payable amountThis plan includes a limitation that fillings
are a benefit only once per tooth in a year periodThis tooth was originally filled on 4/14/2014, so the replacement on 4/12/was within the year periodHowever, since this replacement was only days short of this limit, we have decided to reprocess this claim and provide paymentThe claim originally paid $and the member was responsible for $The new claim is paying $127.60, and the member is responsible for $So her dentist will receive an additional payment of $and apply this to her bill when they receive the payment we are mailing this Thursday, 9/22/If Ms*** has additional questions about the balance due for her dental work, all paid claim information can be found at deltadentalmo.com or by contacting customer service at 1-***Ms*** also asked about the extra benefits that are available due to her immunity diseaseThe option for extra cleanings is referenced in all of the MCHCP dental plan informationI am attaching one page from the web site where footnote explains how to be eligible, and I am also attaching the Self-Report Form which she can complete and send to customer service (fax to *** or email to ***@deltadentalmo.com)Optionally, she can enroll online at deltadentalmo.com.I hope I have answered all of her questionsShould you need any additional information, please let me know.Thanks,*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and received my paymentHopefully future reimbursements won't have to be resolved this way. However, their response is disconcerting because they say that a check was scheduled to be mailed on Feb 3, That would have been more than days from the last time I called and more than days from the day they said the check would be issued (I had it marked on my calendar to call again on Jan because that is days from the last complaint and I was told I could not call again before then and that I they weren't allowed to cancel a check until days after it was issuedI really wish my employer provided another dental insurance alternative because this company seems dishonest. Sincerely,
*** ***

10/16/17 RE: *** ***ID ***We apologize for the delinquent responseSteps have been taken to correct contact information so future correspondence will be handled immediately.Ms*** purchased a dental policy direct from Delta Dental of Missouri's website on or near 5/18/for an
effective date of 7/1/Our eCommerce website contains Summaries of Benefits for all of our plan designs and are accessible to prospective customers, as well as enrolled membersAll enrolled members receive a Welcome Kit which includes a Master Policy immediately after their first premium payment is receivedMaster Policies are also available on our website on demand.We offer dental offices and members a Faxback of benefits to help them and their patients get a better understanding of what their plan coversThe Faxback for Ms*** clearly indicated the Pre-Existing clause in the policy she purchased.Attached are excerpts from the on line Summary of Benefits and Master Policy documents that clearly explain that the policy Ms*** purchased has a Pre Existing clauseWe offer a Predetermination service to our members that wish to understand their benefit levels for specific treatment plans prior to having the work performedOur participating dental offices are familiar with this service and routinely submit predeterminations for their patientsA predetermination was not filed for the service Ms*** had performed.There are several tracked calls on file where Ms*** reached out to speak with our customer service representatives but all were after the procedure was performedWe are always available to help members understand their policiesIt's unfortunate that Ms*** did not contact us or ready the literature that explains in detail the benefits of the plan she purchased Sincerely,Delta Dental of Missouri

Initial Business Response /* (1000, 5, 2015/12/04) */
Contact Name and Title: [redacted] SR VP & COO
Contact Phone: XXX-XXX-XXXX
Contact Email: [redacted]@deltadentalmo.com
Dear Revdex.com,
Ms. [redacted] has filed a complaint regarding her Individual Policy. She contacted us in September after receiving...

her renewal notice for November, which included an increase in premium. At her request, we switched her to a lower cost plan as of 11/1/2015. On November 24th, she contacted us stating she wanted the change made as of January 1. We explained that policy changes are only made at time of renewal. I have reviewed all recorded phone calls between our Delta Dental representatives and Ms. [redacted]. While I regret that this member's perception is that our people are rude, I did not get the same impression when listening to the call recordings. On November 25th, Ms. [redacted] called and notified us that she has put a stop on all future bank charges. We have therefore processed a termination of this policy as of 12/31/2015, since her December premium had been paid on November 19th.
I have prepared a summary of all phone conversations between Ms. [redacted] and Delta Dental representatives. This information will be faxed to the Revdex.com at XXX-XXX-XXXX. Call information needs to remain confidential as it contains Personal Health Information protected by HIPAA.
Should you need any additional information or have questions, please do not hesitate to contact me.
Thanks,
[redacted]
Senior Vice President & COO
[redacted]@deltadentalmo.com
Phone XXX-XXX-XXXX
Initial Consumer Rebuttal /* (3000, 8, 2015/12/04) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I was not properly informed that the date would not be 1 jan 2016 and I did pay them to the end of the year and should have at least one payment coming back. I also state that their people were extremely rude , I guess she's used to it. I remain dissatisfied with Delta Dental. They act as though they are the only business for Dentistry and you are stuck. Thanks but no thanks when it come to them - I have found another BETTER plan immediately!

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.
Sincerely,
[redacted]

Mr. [redacted] purchased an individual dental plan as of 11/1/2015. This plan has a 12 month waiting period before benefits are available for major services. His dental claim for major services rendered on 6/13/16 was denied due to the waiting period. He contacted customer service in August,...

and we explained that the waiting period could be waived with documentation showing (1) he had dental coverage for the 12 months prior to his effective date and (2) that the plan included coverage for major services. He sent proof of 12 months of coverage. We told him we also needed proof that major services were covered by this plan. We were faxed statements from his dental office, but these records did not specify insurance payments were made by the insurance company. These documents were not fraudulent, but they did not include the information we needed. Today we contacted his prior insurance company. They did confirm his plan included major benefits. His claim for $1,475 is being reprocessed and a new Explanation of Benefits will be issued on 9/1/2016. Let me know if any additional information is needed.