Delta Dental

Review: A "C" rating for [redacted] Delta Dental in [redacted] PA is far too generous.

I've been a member since 2006. Last year, it was my understanding [over the phone] that I changed my Plan A billed monthly to yearly for the discounted savings. My 9/24/12 letter regarding my renewal only gave me ETF monthly charges. The only way I would have known how much to pay yearly was if I made that call. On 10-5-12 I issued them a check for a full year $547.44 commencing 12-1-12 thru 12-1-13. That is when my nightmare began. It appears that they kept my full year payment somewhere and pulled it out monthly only to be short at the end of the year. All seemed fine until 10-29-13 when I received a letter stating that my ETF was returned because PNC couldn't locate my account [ that account was closed over 3 years ago when I moved ] and I owed them $30.60. Whatever accounting didn't happen on their end should have been their problem. Instead it's been my nightmare. Over the last 2 months, I've made 17 calls to [redacted] trying to straighten out my bill. Each time I waited no less than 20 minutes to speak to someone in Customer Service only be told that a Supervisor would have to call me back within 24-48 hours. My last contact was a Supervisor named "[redacted]" at ###-###-####". On 1/24/14 he flat out lied to me. I was told that if I gave him the payment today over the phone [ Visa $30.60 ] that his Supervisor agreed to send me a check in same amount within 2 weeks. I was also told that because we were dealing with a third party [ Delta Dental ] that it must be handled this way but that [redacted] would reimburse me. I also left a phone message for [redacted] last week when I realized I was waiting for a check that would never arrive.

My lost time at work making 17 calls, frustration and out right lies is the reason I'm filing this complaint. I've never witnessed such an incompetent and poorly run company that feels the need to lie to its customers.Desired Settlement: In good faith I paid [redacted] Delta Dental for a full year of premiums. I don't feel I owe them the $30.60 that [redacted] tricked me into giving him over the phone.

Business

Response:

February 19, 2014

Review: I purchased dental insurance from Delta Dental beginning in January 2014. Because of limited providers in the plan, I decided to cancel the coverage. I notified Delta Dental by email and formal letter on February 11, 2014 that I was cancelling the coverage as of February 28, 2014. I had already paid the premium for March 2014 and therefore asked that they refund the premium of $45.98. After sending a second email, I received notification from Delta Dental on April 19, 2014 via email that the refund would be mailed out to me right away. I still have not received a check. It is impossible to reach their customer service representatives by telephone. I have waited over an hour and no one will pick up the line. I have tried this many, many times. I have never encountered such poor customer service in my life. I am totally frustrated and feel it is only right that I file this complaint.

Product_Or_Service: Dental Insurance

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Refund

Immediate refund of $45.98.

Business

Response:

Hi [redacted],Delta Dental Insurance is in receipt of your inquiry for member. However, due to potential health information and federal HIPAA regulations, Delta Dental is unable to provide a more substantive response to the Revdex.com regarding the details of the enrollee's complaint. A grievance has been opened on the enrollee's behalf, which will be handled through our internal grievance process and we will respond directly to the enrollee within 30-days. Should you have any questions regarding this matter, you may contact me directly at ###-###-####, extension [redacted], Monday through Friday between the hours of 7:30 a.m. and 4:30 p.m. EST. Sincerely, Ruby L[redacted], SupervisorProfessional Services

Review: I had dental work done on 11/27/12 and 12/5/12. I have my own insurance through [redacted] and have submitted the above claims to [redacted] for reimbursement. I am also secondarily covered under my husband's insurance through Delta Dental. I personally have mailed the claims forms and the EOB's to Delta Dental. When I first called to check on this as some time had gone by I was told that the EOB's from my insurance were not received. I did not understand this as I had stapled them together, however, I then faxed the same info in to a specific person. Again when I called on this, I was advised was not received, but was advised that everything had been found in 2 separate systems and claim would be processed right away. Still no reimbursement lead me to call again and this time I emailed the claim forms and EOBs to a specific person. 3 weeks later I called again & was advised the email had not been received so I emailed the info again while the same person was on the phone. She verified info received and would get claims sent back through. 2 weeks later again I have called and am now advised nothing in system and they will have emailed person contact me. 5 months, several phone calls, & mail, fax, & email later & claims are not resolved!Desired Settlement: I want Delta Dental to issue the reimbursement check we are entitled to and to be penalized for causing such unnecessary frusteration.

Business

Response:

thank you

Review: I began my dental treatment on 04/22/2013, prior to my treatment my dental office viewed my dental coverage as well as myself and based on that information work was done on my mouth, now towards the end of my treatment Delta Dental will not pay for any work preformed stating that I was not covered for any of this work. The work was based on the dental information summary provided by (see attachment).Desired Settlement: The expenses needs to be covered; I dont have the recourses to cover this treatment.

Consumer

Response:

[redacted] <[redacted]

Review: My mother-in-law, [redacted], died on July 28, 2013. Delta Dental has continued to take automatic payments in the amount of $32.13 a month from her account on a monthly basis. We have tried to get the payments stopped to no avail. Yesterday, February 4, 2014, we were finally given a FAX number to which we could send a copy of her death certificate. We have been trying since about 6:00 pm last night until now, February 5 at 8:35 am to send it. The FAX equipment on their end will not answer. There is only one FAX number and it doesn't work. We are told that bad weather may be affecting the equipment. It took my husband weeks just to get in touch with someone at Delta Dental. And now, it appears, the matter will go no further.Desired Settlement: We would like Delta Dental to stop taking payments and to refund the funds taken after my mother in law died. This amounts to $192.78.

Business

Response:

This is in response to your

correspondence concerning the above referenced complainant. Unfortunately, as

this issue pertains to Personal Health Information (PHI) we are unable to

respond directly to the Revdex.com; however, we will accept this as

a formal complaint and respond directly to the member. We appreciate your time in bringing this

matter to our attention.

Review: Purchased dental insurance with DeltaCare as part of the Affordable Healthcare Act. I paid for January and February in advance and my insurance was supposed to go into effect Jan 1st. A week into January and I had received no communication whatsoever from DentalCare and could not access any documents online. At this point I started calling and submitting inquiries on their website every week or so and could not reach a customer care rep. On the phone I would be forced to hold for upwards of 30 min and then get disconnected. The same happened this morning, I actually got thru to a rep, she put me on hold and then I was mysteriously disconnected. I am having no issues with dropped calls or anything of the sort outside of my attempts to reach DentalCare. In February I finally received an email response to one of my online inquiries - I asked to be sent a copy of my welcoming kit and insurance card. The rep's response was that she could not send me a welcoming kit at this time. I asked why and her response was "please do not email this address anymore as it presents a risk to your sensitive information." No sensitive information was being sent. At this point I told her I wanted to cancel my insurance - it's absolutely outrageous that a person can pay for 2 months of insurance in advance and receive no information that would enable them to utilize the policy they paid for. I never received a welcoming kit or an insurance card and after an additional two months of no written communication of any kind I assumed my insurance policy had in fact been canceled. Then in June I started receiving invoices saying I owed additional money. This morning I called again to get this matter resolved and after a 15 min hold I was disconnected....again. This is horrible customer service and I am also afraid that they will try to send my account to collections. I do not want to pay money for an insurance policy I have never had the ability to use, and I already got new insurance which I am paying for every month.

Product_Or_Service: Dental Insurance

Account_Number: Acct # [redacted]Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like my account canceled and all charges after February 2014 voided. I would like confirmation that my account has been closed and that no additional money is due. Quite frankly I should be receiving a refund for January and February as well since I was denied access to my insurance which was already paid for. But at this point, I am willing to chalk up the loss in exchange for peace of mind that this account is closed and can't do me an

Business

Response:

July 21, 2014Dear

[redacted]: Delta

Dental Insurance is in receipt of your inquiry dated July 7/7/2014, regarding

the above referenced policy holder. The

Plan has not received a formal complaint from the policyholder, therefore, one

will be opened on her behalf and the Plan will handle this through our

grievance process and we will respond directly to the enrollee within 30-days. Should

you have any questions regarding this matter, you may contact me directly at ###-###-####, extension [redacted], Monday – Friday between the hours of 7:30 a.m. and

4:15 p.m. EST. Sincerely,Ruby LSupervisorProfessional

Services

Review: I have had a dental ins. plan with the [redacted] Dental Ins. Plan that included my son for approx. 5 yrs. My premium is paid thru auto withdrawal from my bank. I was told that Delta Dental would notify me of any changes to my policy. My son had routine dental work on 10/31/13. I received a bill in the amount of $484.00 that was denied by my dental policy.When I inquired with the company they said he was no longer on my policy due to his age. I said I was never notified of any changes as promised. I told them if I would have been notified of changes I would have insured him. They said they could not see where I was ever notified and that I should file a grievance. I filed a grievance that was received on 1/13/2014. I followed up on my grievance several times, since no ever contacted me. Once was on 1/22/2013, with supervisor, [redacted], who informed me nothing had been done on my complaint and that I had to wait up to 90 days for an answer.I waited 3 months and never received anything back, so I called again today 4/14/2014. I spoke with supervisor, [redacted], who now tells me that a response letter was sent to me on 1/17/2014. I again never received anything from this company. I was told on 1/22 that a response was not sent out yet, so how could it have been sent out on 1/17. This company have NEVER sent me anything concerning my policy as promised and it has been to my detriment. [redacted] told me I would need to send another grievance. I said I wouldn't and ask to speak with her supervisor. I then spoke with [redacted], who seemed to care less, and said that there was nothing he could do but send me the denial letter I never got. I asked to speak with his supervisor, he told me she was not available. I asked for her contact info. He refused to give it to me, saying he could have her call me. I have never received anything as promised from this company. After I told him I would be contacting the Revdex.com I finally got him to give me her contact info.Desired Settlement: I want my claim paid of $484.00 from 10/31/2013, due to the reason the company failed to ever notify me as promised of any changes made to my policy that was to my detriment and if they had of as promised I could have made other arrangements to get my son covered.

Business

Response:

April 16, 2014Dear This is in response to your correspondence concerning the above referenced complainant. Unfortunately, as this issue pertains to Personal Health Information (PHI) we are unable to respond directly to the Revdex.com; however, we will accept this as a formal complaint and respond directly to the member. We appreciate your time in bringing this matter to our attention.This privacy restriction is in compliance with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights, which announced this rule effective September 23, 2013. This privacy rule was created to strengthen the privacy arid security protections for health information established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This restriction means that no Personal Health Information (PHI) belonging to another person can be released to another individual unless the owner of the PHI has provided specific permission to do so*Delta Dental takes enrollee concerns seriously and maintains an internal grievance process to review complaints. As always we recommend that our enroilees submit matters for our review by either contacting customer service at ###-###-#### to submit a grievance over the phone or request a grievance packet to submit it in writing or submit the grievance online on the following page of our website: [redacted]Sincerely,

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

My concerns were never addressed. Their response advises me to file a grievance. It's obvious my complaint was never even read as I had already filed a grievance which was never answered. Delta Dental changed the conditions of my policy to my detriment without notifying me of the changes as they promised me they would, resulting in costing me near $500.00. And now to further prove my point Delta Dental has failed to read or address my concerns to the Revdex.com. I will be contacting the Division of Insurance regulations next. This is ridiculous!

Regards,

Business

Response:

Hello, This is in response to your

correspondence concerning the rejection of our response. Unfortunately, as

this issue pertains to Personal Health Information (PHI) we are unable to

respond directly to the Revdex.com; however, as mentioned before, we will accept this as

a formal complaint and respond directly to the member. We appreciate your time in bringing this

matter to our attention.

Review: Ref.: Delta Dental Case ID: [redacted] When I called [redacted] to inquire about their dental plan, their Customer Service agent told me my specific deep dental cleaning would be covered, so I purchased the plan from her based on her promise.

After I received dental service (the same specific cleaning), they denied my claim.

I sent them a letter, but they denied my appeal claiming that "a telephone inquiry to Delta Dental is not a guarantee of benefits." They wrote that they listened to my telephone conversation with that agent at my request, but they twisted the facts from the record claiming that the agent told me about a different service that would be covered, which is not true. I specifically asked about "deep cleaning", and she said that it would be covered.

Apparently, they did not find the courage to admit their mistake and absorb the loss of some $450 or so, small by their standards by significant for me. This money saving was the only reason I called them and purchased that insurance.Desired Settlement: Reprocess the claim and refund me the money.

Ref.: Delta Dental Case ID: [redacted]

Business

Response:

Please see attached response.

Note- Please sign and return the attached HIPPA form.

Business

Response:

Dear [redacted], This is in response to your correspondence concerning the above referenced complainant #[redacted] file by [redacted] concerning his coverage with the [redacted] Dental Insurance Plan adinistered by Delta Dental. Unfortunately, as this issue pertains to Personal Health Information (PHI) we are unable to respond directly to the Revdex.com; however, we will accept this as a formal complaint and respond directly to the member. We appreciate your time in bringing this matter to our attention. We are sorry [redacted] has not received our previous responses. We wish you to know that Delta Dental has responded to [redacted]'s concerns now on two occasions; September 29, 2014 and October 9, 2014. We will remail our responses to [redacted] at his current address on file, 1440 Gregory Court, Indian Creek, IL 60061. Should you have any questions or concerns please feel free to contact me directly at ###-###-####.

Sincerely,

Eliza

G**

Appeals

Specialist, Subscriber Services

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

Review: I received Delta Dental cards in January of 2014. Upon receiving, I phoned Delta customer service to verify my coverage and was told that I was a covered member. I then made dental appointments and in April, began receiving dental procedures under the assumption I would only be liable for payment of the DELTA contracted expenses that the insurance did not cover. In May 2014, my dental provider and I were informed by Delta Dental that my policy only covered pediatric services which was confusing as I am the only member on my insurance plan. The Delta representative informed that there must have been miscommunication and I was instructed to call my health insurance company, [redacted], because the dental rider was submitted by them. I then called [redacted] and was informed that I do NOT have dental insurance coverage and that a mistake had been made by someone in the department. This mistake is costing me $1,500.00 that I otherwise would not have incurred until I could afford to do so! Multiple calls between Delta Dental and [redacted] did not resolve the matter. On July 14, 2014, I submitted certified letters to the [redacted] Board Chair, [redacted], MD, and the Delta Dental grievance department. As of today, October 13, 2014, I have received no correspondence from the [redacted] chair. I received a letter in September 2014 from Delta Dental's Subscriber Services Department informing me that it was my responsibility to understand my dental coverage (I was employed in the dental field for 5 years and am well aware of what questions to inquire when calling insurance companies) and, conveniently, that there is no record of my initial call to Delta in January confirming my eligibility and no assistance will be made financially.Desired Settlement: I would desire that some, if not all, of the contracted Delta fees be paid by either Delta Dental or [redacted] for the mistake made on their part. Given that my dental provider is contracted with Delta Dental, the total bill for services would be $1,123.00 with payments to be made by Delta of $807.00, leaving a balance of $316.00 to be paid by me (per dental benefits statement). However, the current expected payment to be made by me is $1,515.00 with no contracted Delta fees. If I had been properly informed of my dental insurance situation, I would not have made any appointments until I could afford to do so and feel that I was misrepresented by both insurance companies.

Business

Response:

October 17, 2014Dear This is in response to your

correspondence concerning the above referenced complainant. Unfortunately, as

this issue pertains to Personal Health Information (PHI) we are unable to

respond directly to the Revdex.com; however, please be advised a

formal response was mailed directly to [redacted] explaining the matter on September

5, 2014. In receipt of your inquiry an

additional copy was mailed for confirmation.

We appreciate your time in bringing this matter to our attention.This privacy restriction is in

compliance with the U.S. Department of Health and Human Services (HHS) Office

for Civil Rights, which announced this rule effective September 23, 2013. This

privacy rule was created to strengthen the privacy and security protections for

health information established under the Health Insurance Portability and

Accountability Act of 1996 (HIPAA). This restriction means that no Personal

Health Information (PHI) belonging to another person can be released to another

individual unless the owner of the PHI has provided specific permission to do

so. Delta Dental takes enrollee and

provider concerns seriously and maintains an internal process to review

complaints. Our records indicate this

was matter was addressed with Delta Dental and as stated above a response was

sent to the enrollee on September 5, 2014. Sincerely,Delta Dental Randi

RAppeals Specialist, Subscriber Services

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

Please see attached signed HIPPA form.

Regards,

Business

Response:

October

30, 2014Dear This letter is in response to your

most recent request dated October 21, 2014, concerning the above named patient. At this time we are in receipt of the signed

Authorization for Release of Health Information form required so we may respond

directly to the Revdex.com. Enclosed for your reference are

the following documents:Original response letter dated September 5, 2014.Dental Benefit statement issued July 23, 2014.In review of the above it has

been determined there is no change to the original response sent to the

enrollee. We regret any miscommunication

Ms. Buel feels may have occurred; however, we have no record of a call prior to

the services. I hope we have addressed your

concerns. If you continue to have

further questions I can be reached in the Grievance and Appeals department at

###-###-####.Sincerely,Delta Dental Randi

RAppeals Specialist, Subscriber Services

Consumer

Response:

The company states they do "not have record of my initial phone call." However, this is inaccurate and quite a convenience for them. I'm sure I would be able to provide phone records of my call made to them in the beginning of the 2014 calendar year. Their so-called "miscommunication" falsely represented me and the mistake on their end lead to my being sent to debt collections by my dental provider.

Review: My Daughter is a full time student and still a dependent of mine. On 2/28/2014 she went to have her teeth cleaned at our family dentist. The insurance denied this claim stating she was not ensured. I provided her transcripts to my local Human Resources at work to show in fact she was a full time student. Which at that point they asked me to have my dentist resubmit the claim, which I did. Once again they denied it for the same reason. No I paid the dentist as of 9/5/2014 because they were going to refuse her cleaning for lack of payment and now I am out $314.10. This is not right that I pay my insurance and now I am out the money. I need them to reimburse me the full amount because prevention is paid at 100% per my plan.Desired Settlement: Pay me back the 314.10

Business

Response:

September 8, 2014Dear [redacted]:This letter is in response to

recent correspondence received September 6, 2014 regarding the payment of your

daughter’s claim for services received February 28, 2014. We understand the

claim was disallowed due to missing student status and this information has

been provided to your employer. You

would like the claim paid. We appreciate you taking the time to write and want

you to know that your concerns are very important to us. The claim in question has been

processed with a Delta Dental Provider Claim Payment of $140.00 to the dental

office on September 3, 2014. A Delta

Dental Benefits Statement was sent to you at that time indicating no patient

responsibility. The group updated

eligibility with Delta Dental on August 22, 2014 which allowed us to reprocess

the claim. I sincerely apologize for any

inconvenience this may have caused you or your dental office. I hope we have addressed your

concerns in this matter to your satisfaction.

Please feel free to call me if you have any questions. Our toll-free number is ###-###-#### and my

extension is [redacted].Sincerely,Delta

Dental

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

3 Reasons I reject this

First - I am personally

out 314.10 for this due to the refusal of paying this claim. This is Delta

Dentals responsibly to pay me ALL of this due to their screw up.

Second – I provided this information in May of 2014 and had

it resubmitted per there guidance which they once again rejected, again showing

it is there responsibly.

Third – Under my benefits it clearly States Children Covered

until 26 It does not state Student Children covered until 26. All of these show

how they just want to screw people.

Regards,

Business

Response:

The claim was paid in full, you may contact the office for a refund or your overpayment.The claim paid according to your plan's benefits.We have been requested to obtain student status.