We have contacted the customer and have reinstated her under our DentaQuest Individual Plan. The prior dental plan was terminated and retroactively terminated at the direction of the Federal Market Place. The amount of $that was on the account is being transferred to the new plan
and has been agreed to by the customer
Dear Mr***,
It was a pleasure speaking with you on 2/28/17. I have received confirmation from our Finance/Billing team that your plan (***, which terminated on 5/31/16, does not have a balance due. Your wife's plan (***), is currently active, and the request to
previously due balance of $was approved and as of right now there's no current balance on the account as we applied a check in the amount of $to the account on 2/28/17. This check applied, plus the credit given of $brings your account current through April 30th, 2017. The April invoice should reflect the credit provided, but may not necessarily show the check posted as it was posted after our internal cut-off date of the 27th
We are still investigating the issues regarding the online portal, and I will continue to work with our IT department to ensure you are successful in logging on. I provided you my direct number should any other issues arise
Thank you,
*** ***
Hello,
We have requested a refund of $to be sent to Mr***. We were unsuccessful in reaching the complainant over the phone so we can extend a courtesy credit in hopes of retaining his business. He was provided a direct phone # here at DentaQuest (Customer Service Supervisor:
*** ***) in the voicemail should he not receive his check in 7-business days. His account has been terminated and future invoices will be suppressed.
Thank you,
*** ***
(responding for *** ***)
Dear Mr***,
Please be advised that the invoicing is automated and it the timing was off. As stated in the last response and voicemail, please allow 7-business days to receive your refund check. Also in your voicemail, I left you a direct number contact number for myself (*** ***) should you not receive the refund check in the time frame previously stated
Once you receive the refund check, you should not receive any additional invoices, or credit invoices
Thank you for your time,
*** *** (Responding for *** ***)
Dear Mr***,
It was a pleasure speaking with you on 2/28/and 3/2/17. I have received confirmation from our Finance/Billing team that your plan (***, which terminated on 5/31/16, does not have a balance due. Your wife's plan (***), is currently active, and the request to waive/credit, the previously due balance of $was approved and as of right now there's no current balance on the account. We received and applied a check in the amount of $to the account on 2/28/17. With this this check applied, plus the credit given of $brings your account current through April 30th, 2017. The April invoice should reflect the credit provided, but may not necessarily show the check posted as it was posted after our internal cut-off date of the 27thWe are still investigating the issues regarding the online portal, and I will continue to work with our IT department to ensure you are successful in logging on. I provided you my direct number should any other issues arise
Thank you,
*** ***
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below.
I did receive a call from Dentaquest confirming the details of the complaint and that they intend to process it. No resolution has been arrived at therefore this complaint is still open.
Regards,
[redacted]
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]....
Please add your rejection comments below.
The response is vague and lacks any specifics on what action the business will take.
Regards,
[redacted]
Hi,
We did not receive this original complaint. The second notification of this complaint was received by us on Sunday, February 12th. I am out of the office and have an out of office rule, and will be returning to the office on Wednesday, February 15th. In my absence I have had...
[redacted] work on this issue and he is attempting to respond to the complaint.
Also, I received a call from [redacted] last Wednesday and supplied all of my contact information. [redacted] reached out to her today and has made her aware of the current circumstances surrounding this issue and is attempting to resolve this matter. We can and will refund the money to the complainant, but first are trying to contact this member to make the situation right, but giving a credit and attempting to retain his business.
I respectfully ask that since the first time we were aware and contacted on this complaint was the end of last week, that this not be closed as no response. The Admin of the Office of the CEO put [redacted] in contact with me as the last contact on record was [redacted], who was our prior CEO 2 years ago. I believe that this was sent to her in error and that is why it was not received. Now [redacted] at Revdex.com has updated all records and contacts to have me listed as the point of contact for these matters.
Thank you,
[redacted]
[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.]
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved.
Regards,
[redacted] Birthday is May 15, 1967 My member ID # is [redacted]. The screenshot submitted has my member number listed.
Issue: A complaint was submitted to the Revdex.com on October 7, 2016. Ms. ** had the following concerns:
On 4/21/16 Ms. [redacted] stated she went to dentist offices for routine 6 month cleaning. The claim did not pay with reason: system error wait for IT fix with no ETA. Ms. ** stated the dentist office cannot wait since they need fund to operate their service. Ms. ** stated that she keeps calling every month but the problem still was not fix. In the month of July, the dentist office asked Ms. ** to pay for service on 4/21/16 before they gave an appointment to her husband. Ms. ** stated she called DentaQuest again and they stated they would be reprocessing the claim & pay the following week and approve for her husband service on 7/18/16.On 7/18/16 Ms. **’s husband went for 6 month routine cleaning with approval and Ms. ** called the insurance ahead. The claim didn’t pay in July & Aug. On 9/20/16 Ms. Ha stated she received a letter saying a small amount was paid; paid for code: D1110 but didn’t pay for code D0120, D1208, D1330 even though the codes on the columns are approved and plan pays 100%.
Response: DentaQuest did identify a technical issue where some codes were not paying on claims under the TX DentaQuest Personal Plans. DentaQuest reviewed Ms. **’s claims history and identified claim [redacted] for DOS 4/21/2016 for Ms. ** and claim [redacted] for DOS 7/18/2016 for [redacted]. Ms. **’s claim was requested to be approved for payment and processed to pay for the amount of $85.61. On the second claim for Mr. [redacted] for DOS 7/18/2016, codes D0120, D1208, D1330 were submitted to be approved for payment on claim 2[redacted]3300 for $41.75. Code D1110 had previously been approved on a resubmitted claim by the same dentist; claim [redacted] was approved to pay for the amount of $32.10 and provider was paid on 9/21/2016 for this amount.
DentaQuest contacted Ms. ** on 10/17/2016 to explain both claims were approved to pay and provider would be paid the approved balances within 1-2 weeks of approval. Ms. ** requested that DentaQuest contact the office of Dr. [redacted] to confirm the claims were approved because they are still billing Ms. **. DentaQuest left a voicemail for Dr. [redacted]’s office at ###-###-#### and will follow up with another phone call to verbally confirm the approved claims.
Please advise if you require additional information or if you have any questions feel free to reach me directly at ###-###-#### or, if you prefer, my email address is [redacted]@dentaquest.com
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. .
I did NOT receive a check as stated, for the settlement of useless services from DentaQuest in 2016 but received a [redacted] with a credit for CONTINUED services through 2017, which was NOT authorized by me, through the affordable care act.Please find the attached [redacted] I received TODAY 2/16/17Regards,
[redacted]
Hello,
Contacted Mr. [redacted] today, advised that a third refund check in the amount of $127.61 was requested yesterday and they should receive the check within 7-10 business days. We have already sent out two refund checks, one for $17.28 on 7/22/16 and the other for $34.56 on 10/26/16. The total of all three refunds is $179.45 which equals the amount of all premiums paid to DentaQuest. A voicemail was left on the member's answering machine (ph#: [redacted]) with a direct phone number (Customer Service Supervisor: [redacted]) should the member not receive the refund check in 7-10 business days.
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. .
I have not received any contact from DentaQuest representatives, it seems from their late response to Revdex.com, they have major issues with their management, very telling. I will await further notice. thank YOU Revdex.com
Regards,
[redacted]
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted].
Please reword ambiguous sentence. Thanks!
Regards,
[redacted]
November 24, 2015DentaQuest of VirginiaMs. [redacted]
[redacted]RE: File Number: [redacted] Complainant: [redacted]...
[redacted] Member Number: [redacted]Dear Ms. [redacted],Issue: A complaint was submitted to the Revdex.com on June 23, 2015. Ms. [redacted] cancelled his with DentQuest policy on March 31, 2015. According to Ms. [redacted] he called several times inquiring about a refund however, his date kept getting pushed back. When following up with DentaQuest on June 19, 2015 Ms. [redacted] was advised that DentaQuest’s systems were down, as a result a call back was scheduled for the following business day.Member has concerns that he will be sent to a collection agency regarding his account. An invoice was received by the member after the account was closed, based off the information in the complaint it appears the member is under the impression that he may be sent to collections. Member wishes to have a documentation proving his account is closed.Response: DentaQuest issued a refund check to Ms. [redacted] on June 26, 2015 in the amount of $25.49. Ms. [redacted] confirmed receipt of the reimbursement check that was sent to him by DentaQuest. DentaQuest mailed an invoice for billing period 11/01/2015 – 11/30/2015 clearing Ms. [redacted] from all debt associated with DentaQuest. The total amount due showed a zero dollar balance, the Premium amount due showed a refund of ($25.49). DentaQuest verified that Ms. [redacted]’s account has a zero balance, this information is accurate and the invoice received was to inform Ms. [redacted] of the refund and zero balance. DentaQuest will not refer the Ms. [redacted] to a Collection Agency.DentaQuest made contact with Ms. [redacted] on November 24, 2015 and notified her that was no balance on her account to be paid. Ms. [redacted] was satisfied with outcome and expects written confirmation of the information provided above.Please let me know if you need any additional information or if you have any questions feel free to reach me directly at [redacted] Ext [redacted], or, if you prefer, my email address is [redacted]@DentaQuest.com.Sincerely,[redacted]Supervisor Complaints and Grievances
Issue:
DentaQuest received a facsimile remittance sent to number ###-###-#### on September 30, 2016 regarding a complaint that was mailed by [redacted] to the Texas Department of Insurance on July 25 2016. The documentation included a letter from Texas...
Department of Insurance asking that a written response be provided no later than fifteen (15) days from the date letter is received. Included in the remittance was a letter written by [redacted] addressed to Texas Department of Insurance, a copy of the Complaint Form for member Tracey [redacted], ID number [redacted] referencing claim number [redacted].
In the letter addressed to Texas Department of Insurance Ms. [redacted] stated she was
seeking to file a complaint through DentaQuest on behalf of her daughter’s previous dentist. Ms. [redacted] stated she were told over four times how things were going to proceed by DentaQuest; however each time she called, she was given different information on how to proceed with her claim. Ms. [redacted] states she was told she would be contacted and she was not. Ms. [redacted] stated when she called back she was informed the previous person she spoke with gave her wrong information. Ms. [redacted] stated this happened on numerous occasions and most importantly she was told she would be contacted so she could provide additional information about her complaint. Ms. [redacted] stated that instead she was contacted advising the case had been investigated and closed without given the opportunity to submit all of her information. Ms. [redacted] states she was told this after calling and spending numerous hours on the phone trying to seek help from someone at DentaQuest and getting nowhere. Ms. [redacted] stated if proper protocol had been followed, obtaining full information and facts in order to do a thorough investigation would have been sufficient before closing the case.
Findings:
DentaQuest reviewed [redacted]’s member history and found a complaint filed by Mr. [redacted] on May 17th 2016 by calling DentaQuest Member Services. Mr. [redacted]’s complaint was regarding [redacted]’s visit to Dr. [redacted] on March 2014. In the complaints Mr. [redacted] stated Dr. [redacted] advised the parents not to have a cavity fixed, and that he was just going to watch it. Mr. [redacted] stated this was the provider's advice for a long period of time. Then one day Dr. [redacted] took an x-ray and said [redacted] needed a filling, but said she was too big and the office didn’t have the adult tools. Mr. [redacted] stated Dr. [redacted] refused to do dental work on the cavity; but he did an adult cleaning so he was confused about the dental office not having the adult tools. The cavity became a major, deep cavity and [redacted]'s new provider stated they may not be able to save the tooth. Mr. [redacted] stated he witnessed the provider seeing six patients at once, and that he had them all in a row. Mr. [redacted] stated he believed Dr. [redacted] wouldn’t do anything that required work. Mr. [redacted] stated he felt time was wasted and his daughter should have gotten a sealant or something to prevent this from happening and believes the dentist did have the tools.
On June 14th, 2016 DentaQuest spoke to [redacted] at the front desk at the office of Dr. [redacted] and [redacted] stated that the office had the tools to repair cavities on permanent primary teeth only. DentaQuest requested x-rays and treatment notes for dental consultant review. The request for documents was forwarded to Brandy, the surgical coordinator at the office. Brandy called DentaQuest back to explain that there was a large gap in treatment time for [redacted]. DentaQuest requested the notes dating back from the time the cavity was first documented at the provider’s office. On the same day, June 14th, 2016, DentaQuest spoke with Ms. [redacted] at 2:27 pm. Ms. [redacted] stated that all of the providers in the office had not properly treated [redacted]. Ms. [redacted] stated that Dr. [redacted] was the primary care physician and saw patients from the beginning and he had dismissed [redacted] because the office didn’t have the proper tools to work on her teeth. Ms. [redacted] sated that Dr. [redacted] prescribed fluoride toothpaste rather than repairing the tooth. Ms. [redacted] stated the dentist didn’t have time to do the work on the tooth. Ms. [redacted] stated that one molar was the biggest concern because the provider took a bad x-ray and [redacted]’s new provider stated the member needed a new x-ray. During the conversation, Ms. [redacted] did not state she had additional documentation to provide to DentaQuest. An acknowledgement letter mailed on June 9th, 2016 contained the mailing address where any documents or records pertaining to the complaint could be mailed. Ms. [redacted] would have had an opportunity to provide any documents mail or alternative format (email, fax) should she have requested during the phone conversation with DentaQuest on June 14th. If Ms. [redacted]’s primary method of sending documents was via mail, an extension would have been requested to complete the investigation to allow Ms. [redacted] time.
All documents were received from Dr. [redacted]’ office and were sent to a DentaQuest dental consultant for review. The resolution was as follows:
“A DentaQuest Dental Consultant received and reviewed your complaint. Parents’ statements and Provider’s documents (x-rays, treatment notes, progress notes) were reviewed. Incipient lesions were placed on a watch protocol in March of 2014. Again at the October 2014 recall exam, lesions were placed on a watch. The member did not return to the office on a regular 6-month visit after October 10, 2014 to allow the provider to monitor these watches. The member returned for a recall visit 1.5 year later on 03/03/2016 resulting in findings of active decay requiring treatment. Placing incipient decay on a watch adheres to standard practice protocols for small lesions or lesions localized to the outer layer of the tooth structure. At every visit, the office reinforced dietary and oral hygiene as part of this standard practice. There is no evidence of clinical quality of care issues as 1.5 year is sufficient time for decay to progress. Pediatric offices have the option to refer treatment to general dentists to treat adult teeth. Tools for adult cleanings are not related to tools for restorative dentistry.”
DentaQuest called Ms. [redacted] at on October 7, 2016 at 10:35 am. A recap of the complaint was discussed with Ms. [redacted] and she was asked if she had new documents she would like DentaQuest to consider regarding the complaint that was filed on May 17th, 2016 that had not already been reviewed. Ms. [redacted] stated she did not have any new information and this complaint could be dismissed. Ms. [redacted] stated she is now happy with the dentist [redacted] is currently seeing and there was no need to pursue her complaint further. Ms. [redacted] was informed she can reach out to DentaQuest Member Services for any assistance regarding [redacted]’s dental plan [redacted].
Please feel free to contact me with any further questions you may have.
Sincerely,
[redacted]
Complaints Grievances and Appeals Specialist
###-###-####
[redacted]
DentaQuest spoke to Ms. [redacted] on 12/12/2016 and explained that DentaQuest did not receive the request from [redacted] to cancel her policy that had been set up in error. Ms. [redacted] was advised that her DentaQuest policy has been canceled and backdated to 8/01/2016. DentaQuest would...
like to apologize to Ms. [redacted] for any inconvenience this may have caused Ms. [redacted].
Please advise if you require additional information or if you have any questions feel free to reach me directly at [redacted] or, if you prefer, my email address is [redacted]
We have contacted the customer and have reinstated her under our DentaQuest Individual Plan. The prior dental plan was terminated and retroactively terminated at the direction of the Federal Market Place. The amount of $that was on the account is being transferred to the new plan
and has been agreed to by the customer
Hello,
your request has been received and will be processed accordingly
thank you
Dear Mr***,
It was a pleasure speaking with you on 2/28/17. I have received confirmation from our Finance/Billing team that your plan (***, which terminated on 5/31/16, does not have a balance due. Your wife's plan (***), is currently active, and the request to
previously due balance of $was approved and as of right now there's no current balance on the account as we applied a check in the amount of $to the account on 2/28/17. This check applied, plus the credit given of $brings your account current through April 30th, 2017. The April invoice should reflect the credit provided, but may not necessarily show the check posted as it was posted after our internal cut-off date of the 27th
We are still investigating the issues regarding the online portal, and I will continue to work with our IT department to ensure you are successful in logging on. I provided you my direct number should any other issues arise
Thank you,
*** ***
Hello,
We have requested a refund of $to be sent to Mr***. We were unsuccessful in reaching the complainant over the phone so we can extend a courtesy credit in hopes of retaining his business. He was provided a direct phone # here at DentaQuest (Customer Service Supervisor:
*** ***) in the voicemail should he not receive his check in 7-business days. His account has been terminated and future invoices will be suppressed.
Thank you,
*** ***
(responding for *** ***)
Dear Mr***,
Please be advised that the invoicing is automated and it the timing was off. As stated in the last response and voicemail, please allow 7-business days to receive your refund check. Also in your voicemail, I left you a direct number contact number for myself (*** ***) should you not receive the refund check in the time frame previously stated
Once you receive the refund check, you should not receive any additional invoices, or credit invoices
Thank you for your time,
*** *** (Responding for *** ***)
Dear Mr***,
It was a pleasure speaking with you on 2/28/and 3/2/17. I have received confirmation from our Finance/Billing team that your plan (***, which terminated on 5/31/16, does not have a balance due. Your wife's plan (***), is currently active, and the request to waive/credit, the previously due balance of $was approved and as of right now there's no current balance on the account. We received and applied a check in the amount of $to the account on 2/28/17. With this this check applied, plus the credit given of $brings your account current through April 30th, 2017. The April invoice should reflect the credit provided, but may not necessarily show the check posted as it was posted after our internal cut-off date of the 27thWe are still investigating the issues regarding the online portal, and I will continue to work with our IT department to ensure you are successful in logging on. I provided you my direct number should any other issues arise
Thank you,
*** ***
Good afternoon,
Please provide additional member informationi.eMember ID or DOB in order to appropriately identify member
thank you,
*** ** ***
*
Made contact with Mr***, advised him we are in receipt of his complaint and will begin the process
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below.
I did receive a call from Dentaquest confirming the details of the complaint and that they intend to process it. No resolution has been arrived at therefore this complaint is still open.
Regards,
[redacted]
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]....
Please add your rejection comments below.
The response is vague and lacks any specifics on what action the business will take.
Regards,
[redacted]
Hi,
We did not receive this original complaint. The second notification of this complaint was received by us on Sunday, February 12th. I am out of the office and have an out of office rule, and will be returning to the office on Wednesday, February 15th. In my absence I have had...
[redacted] work on this issue and he is attempting to respond to the complaint.
Also, I received a call from [redacted] last Wednesday and supplied all of my contact information. [redacted] reached out to her today and has made her aware of the current circumstances surrounding this issue and is attempting to resolve this matter. We can and will refund the money to the complainant, but first are trying to contact this member to make the situation right, but giving a credit and attempting to retain his business.
I respectfully ask that since the first time we were aware and contacted on this complaint was the end of last week, that this not be closed as no response. The Admin of the Office of the CEO put [redacted] in contact with me as the last contact on record was [redacted], who was our prior CEO 2 years ago. I believe that this was sent to her in error and that is why it was not received. Now [redacted] at Revdex.com has updated all records and contacts to have me listed as the point of contact for these matters.
Thank you,
[redacted]
[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.]
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved.
Regards,
[redacted] Birthday is May 15, 1967 My member ID # is [redacted]. The screenshot submitted has my member number listed.
October 17, 2015
DentaQuest
[redacted]
[redacted] FL, [redacted]
RE: File Number: [redacted]
Complainant: ...
[redacted]
Member Number: [redacted]
Dear Mrs. **,
Issue: A complaint was submitted to the Revdex.com on October 7, 2016. Ms. ** had the following concerns:
On 4/21/16 Ms. [redacted] stated she went to dentist offices for routine 6 month cleaning. The claim did not pay with reason: system error wait for IT fix with no ETA. Ms. ** stated the dentist office cannot wait since they need fund to operate their service. Ms. ** stated that she keeps calling every month but the problem still was not fix. In the month of July, the dentist office asked Ms. ** to pay for service on 4/21/16 before they gave an appointment to her husband. Ms. ** stated she called DentaQuest again and they stated they would be reprocessing the claim & pay the following week and approve for her husband service on 7/18/16.On 7/18/16 Ms. **’s husband went for 6 month routine cleaning with approval and Ms. ** called the insurance ahead. The claim didn’t pay in July & Aug. On 9/20/16 Ms. Ha stated she received a letter saying a small amount was paid; paid for code: D1110 but didn’t pay for code D0120, D1208, D1330 even though the codes on the columns are approved and plan pays 100%.
Response: DentaQuest did identify a technical issue where some codes were not paying on claims under the TX DentaQuest Personal Plans. DentaQuest reviewed Ms. **’s claims history and identified claim [redacted] for DOS 4/21/2016 for Ms. ** and claim [redacted] for DOS 7/18/2016 for [redacted]. Ms. **’s claim was requested to be approved for payment and processed to pay for the amount of $85.61. On the second claim for Mr. [redacted] for DOS 7/18/2016, codes D0120, D1208, D1330 were submitted to be approved for payment on claim 2[redacted]3300 for $41.75. Code D1110 had previously been approved on a resubmitted claim by the same dentist; claim [redacted] was approved to pay for the amount of $32.10 and provider was paid on 9/21/2016 for this amount.
DentaQuest contacted Ms. ** on 10/17/2016 to explain both claims were approved to pay and provider would be paid the approved balances within 1-2 weeks of approval. Ms. ** requested that DentaQuest contact the office of Dr. [redacted] to confirm the claims were approved because they are still billing Ms. **. DentaQuest left a voicemail for Dr. [redacted]’s office at ###-###-#### and will follow up with another phone call to verbally confirm the approved claims.
Please advise if you require additional information or if you have any questions feel free to reach me directly at ###-###-#### or, if you prefer, my email address is [redacted]@dentaquest.com
Sincerely,
[redacted]
Supervisor Complaints and Grievances
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. .
I did NOT receive a check as stated, for the settlement of useless services from DentaQuest in 2016 but received a [redacted] with a credit for CONTINUED services through 2017, which was NOT authorized by me, through the affordable care act.Please find the attached [redacted] I received TODAY 2/16/17Regards,
[redacted]
Hello,
Contacted Mr. [redacted] today, advised that a third refund check in the amount of $127.61 was requested yesterday and they should receive the check within 7-10 business days. We have already sent out two refund checks, one for $17.28 on 7/22/16 and the other for $34.56 on 10/26/16. The total of all three refunds is $179.45 which equals the amount of all premiums paid to DentaQuest. A voicemail was left on the member's answering machine (ph#: [redacted]) with a direct phone number (Customer Service Supervisor: [redacted]) should the member not receive the refund check in 7-10 business days.
Thank you,
[redacted]
(answering for [redacted])
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. .
I have not received any contact from DentaQuest representatives, it seems from their late response to Revdex.com, they have major issues with their management, very telling. I will await further notice. thank YOU Revdex.com
Regards,
[redacted]
Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted].
Please reword ambiguous sentence. Thanks!
Regards,
[redacted]
November 24, 2015DentaQuest of VirginiaMs. [redacted]
[redacted]RE: File Number: [redacted] Complainant: [redacted]...
[redacted] Member Number: [redacted]Dear Ms. [redacted],Issue: A complaint was submitted to the Revdex.com on June 23, 2015. Ms. [redacted] cancelled his with DentQuest policy on March 31, 2015. According to Ms. [redacted] he called several times inquiring about a refund however, his date kept getting pushed back. When following up with DentaQuest on June 19, 2015 Ms. [redacted] was advised that DentaQuest’s systems were down, as a result a call back was scheduled for the following business day.Member has concerns that he will be sent to a collection agency regarding his account. An invoice was received by the member after the account was closed, based off the information in the complaint it appears the member is under the impression that he may be sent to collections. Member wishes to have a documentation proving his account is closed.Response: DentaQuest issued a refund check to Ms. [redacted] on June 26, 2015 in the amount of $25.49. Ms. [redacted] confirmed receipt of the reimbursement check that was sent to him by DentaQuest. DentaQuest mailed an invoice for billing period 11/01/2015 – 11/30/2015 clearing Ms. [redacted] from all debt associated with DentaQuest. The total amount due showed a zero dollar balance, the Premium amount due showed a refund of ($25.49). DentaQuest verified that Ms. [redacted]’s account has a zero balance, this information is accurate and the invoice received was to inform Ms. [redacted] of the refund and zero balance. DentaQuest will not refer the Ms. [redacted] to a Collection Agency.DentaQuest made contact with Ms. [redacted] on November 24, 2015 and notified her that was no balance on her account to be paid. Ms. [redacted] was satisfied with outcome and expects written confirmation of the information provided above.Please let me know if you need any additional information or if you have any questions feel free to reach me directly at [redacted] Ext [redacted], or, if you prefer, my email address is [redacted]@DentaQuest.com.Sincerely,[redacted]Supervisor Complaints and Grievances
Dear Sir/Madam:
Issue:
DentaQuest received a facsimile remittance sent to number ###-###-#### on September 30, 2016 regarding a complaint that was mailed by [redacted] to the Texas Department of Insurance on July 25 2016. The documentation included a letter from Texas...
Department of Insurance asking that a written response be provided no later than fifteen (15) days from the date letter is received. Included in the remittance was a letter written by [redacted] addressed to Texas Department of Insurance, a copy of the Complaint Form for member Tracey [redacted], ID number [redacted] referencing claim number [redacted].
In the letter addressed to Texas Department of Insurance Ms. [redacted] stated she was
seeking to file a complaint through DentaQuest on behalf of her daughter’s previous dentist. Ms. [redacted] stated she were told over four times how things were going to proceed by DentaQuest; however each time she called, she was given different information on how to proceed with her claim. Ms. [redacted] states she was told she would be contacted and she was not. Ms. [redacted] stated when she called back she was informed the previous person she spoke with gave her wrong information. Ms. [redacted] stated this happened on numerous occasions and most importantly she was told she would be contacted so she could provide additional information about her complaint. Ms. [redacted] stated that instead she was contacted advising the case had been investigated and closed without given the opportunity to submit all of her information. Ms. [redacted] states she was told this after calling and spending numerous hours on the phone trying to seek help from someone at DentaQuest and getting nowhere. Ms. [redacted] stated if proper protocol had been followed, obtaining full information and facts in order to do a thorough investigation would have been sufficient before closing the case.
Findings:
DentaQuest reviewed [redacted]’s member history and found a complaint filed by Mr. [redacted] on May 17th 2016 by calling DentaQuest Member Services. Mr. [redacted]’s complaint was regarding [redacted]’s visit to Dr. [redacted] on March 2014. In the complaints Mr. [redacted] stated Dr. [redacted] advised the parents not to have a cavity fixed, and that he was just going to watch it. Mr. [redacted] stated this was the provider's advice for a long period of time. Then one day Dr. [redacted] took an x-ray and said [redacted] needed a filling, but said she was too big and the office didn’t have the adult tools. Mr. [redacted] stated Dr. [redacted] refused to do dental work on the cavity; but he did an adult cleaning so he was confused about the dental office not having the adult tools. The cavity became a major, deep cavity and [redacted]'s new provider stated they may not be able to save the tooth. Mr. [redacted] stated he witnessed the provider seeing six patients at once, and that he had them all in a row. Mr. [redacted] stated he believed Dr. [redacted] wouldn’t do anything that required work. Mr. [redacted] stated he felt time was wasted and his daughter should have gotten a sealant or something to prevent this from happening and believes the dentist did have the tools.
On June 14th, 2016 DentaQuest spoke to [redacted] at the front desk at the office of Dr. [redacted] and [redacted] stated that the office had the tools to repair cavities on permanent primary teeth only. DentaQuest requested x-rays and treatment notes for dental consultant review. The request for documents was forwarded to Brandy, the surgical coordinator at the office. Brandy called DentaQuest back to explain that there was a large gap in treatment time for [redacted]. DentaQuest requested the notes dating back from the time the cavity was first documented at the provider’s office. On the same day, June 14th, 2016, DentaQuest spoke with Ms. [redacted] at 2:27 pm. Ms. [redacted] stated that all of the providers in the office had not properly treated [redacted]. Ms. [redacted] stated that Dr. [redacted] was the primary care physician and saw patients from the beginning and he had dismissed [redacted] because the office didn’t have the proper tools to work on her teeth. Ms. [redacted] sated that Dr. [redacted] prescribed fluoride toothpaste rather than repairing the tooth. Ms. [redacted] stated the dentist didn’t have time to do the work on the tooth. Ms. [redacted] stated that one molar was the biggest concern because the provider took a bad x-ray and [redacted]’s new provider stated the member needed a new x-ray. During the conversation, Ms. [redacted] did not state she had additional documentation to provide to DentaQuest. An acknowledgement letter mailed on June 9th, 2016 contained the mailing address where any documents or records pertaining to the complaint could be mailed. Ms. [redacted] would have had an opportunity to provide any documents mail or alternative format (email, fax) should she have requested during the phone conversation with DentaQuest on June 14th. If Ms. [redacted]’s primary method of sending documents was via mail, an extension would have been requested to complete the investigation to allow Ms. [redacted] time.
All documents were received from Dr. [redacted]’ office and were sent to a DentaQuest dental consultant for review. The resolution was as follows:
“A DentaQuest Dental Consultant received and reviewed your complaint. Parents’ statements and Provider’s documents (x-rays, treatment notes, progress notes) were reviewed. Incipient lesions were placed on a watch protocol in March of 2014. Again at the October 2014 recall exam, lesions were placed on a watch. The member did not return to the office on a regular 6-month visit after October 10, 2014 to allow the provider to monitor these watches. The member returned for a recall visit 1.5 year later on 03/03/2016 resulting in findings of active decay requiring treatment. Placing incipient decay on a watch adheres to standard practice protocols for small lesions or lesions localized to the outer layer of the tooth structure. At every visit, the office reinforced dietary and oral hygiene as part of this standard practice. There is no evidence of clinical quality of care issues as 1.5 year is sufficient time for decay to progress. Pediatric offices have the option to refer treatment to general dentists to treat adult teeth. Tools for adult cleanings are not related to tools for restorative dentistry.”
DentaQuest called Ms. [redacted] at on October 7, 2016 at 10:35 am. A recap of the complaint was discussed with Ms. [redacted] and she was asked if she had new documents she would like DentaQuest to consider regarding the complaint that was filed on May 17th, 2016 that had not already been reviewed. Ms. [redacted] stated she did not have any new information and this complaint could be dismissed. Ms. [redacted] stated she is now happy with the dentist [redacted] is currently seeing and there was no need to pursue her complaint further. Ms. [redacted] was informed she can reach out to DentaQuest Member Services for any assistance regarding [redacted]’s dental plan [redacted].
Please feel free to contact me with any further questions you may have.
Sincerely,
[redacted]
Complaints Grievances and Appeals Specialist
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[redacted]
DentaQuest spoke to Ms. [redacted] on 12/12/2016 and explained that DentaQuest did not receive the request from [redacted] to cancel her policy that had been set up in error. Ms. [redacted] was advised that her DentaQuest policy has been canceled and backdated to 8/01/2016. DentaQuest would...
like to apologize to Ms. [redacted] for any inconvenience this may have caused Ms. [redacted].
Please advise if you require additional information or if you have any questions feel free to reach me directly at [redacted] or, if you prefer, my email address is [redacted]