DentaQuest

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below only one message was left from only one attempt to reach me during my working hoursI can be reached after 5pm any day of the week or on weekends Regards,

Dear [redacted] Problem Report ID: [redacted] DentaQuest Case #: [redacted] Member Name and ID: [redacted] , [redacted] Issue: Member stated she had purchased dental insurance through DentaQuest at the end of last year and established an online account after receiving an invoice in JanuaryThe member was able to successfully pay the premiums for January and February using the online accountWhen the member went to the dental office she was informed her coverage was terminated as of 1/1/The member proceeded to have a dental cleaning performed at the dental office Mrs [redacted] states that if her membership or payment had an issue the system should have flagged or indicated that her membership was terminated when she was making her payments The member is disputing an amount of $Action/Findings: on March 25, Mrs [redacted] contacted our Customer Services Department and was informed by one of our representatives that her dental plan was termed for late paymentThe member was told to send in her payments by mail for March and April premiums to have it re-instated AS of today we have no dental claims on file for this member to indicate the Provider office was seen atWe have attempted to contact the member with no response on four different occasions to request a copy of the treatment plan that was presented to her as this will serve as confirmation of the provider’s information and DOS the member was treated on We have also left Voice messages indicating our contact information so that she may return our callsCurrently, the member is retroactively showing active as of 1/1/We did not receive a call back from the member Final Resolution: Our systems show that the member has been re-instated with a retroactive date of January 1, We will need to obtain the members treatment plan or claim form from the office to process her charges accordingly to her plan Given that the member did not state what office or dentist treated her and with no successful contact with the member to obtain required information, we will need to close this case at this timeShould the member contact our Customer Services Department once again, they may provide her with her current membership statusShould you have further questions concerning this complaint, you may contact me directly at ###-###-#### Ext***Sincerely, [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 made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, [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 made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, Jonathan [redacted]

Dentaquest sent an automated reminder call at 1:57AM to my phone, thus waking up the whole house, included my child who was sick. I truly hate this company because it's impossible to reach a live person on the line and it's just a cold, impersonal robot. There is nothing I can do to stop the calls other than be forced to turn off my phone.

DentaQuest has received and acknowledged your complaintContact will be made with the member and case will be handled internally
thank you,
Nic

DentaQuest reviewed Alberto ***’s member profile and claims history and found no authorizations submitted by Coast Dental. DentaQuest did find claim *** submitted by the office for date of service 3/13/for an evaluation and x-rays. DentaQuest called Ms***
and she stated that according to Coast Dental, the office had submitted the authorization on 3/13/and DentaQuest had yet to process the authorization. Ms*** was explained that according to Alberto’s profile, there was no authorization found on file. Ms*** agreed to email the copy of the authorization she was given at Coast Dental. After review of the authorization, the authorization was written out on a ADA claim form. DentaQuest called Coast Dental and spoke with Laurie, *** ***. Laurie stated that their office sent the authorization on behalf of Alberto on 3/13/but had not heard back from DentaQuest and had not called DentaQuest to get a follow upLaurie did not have a confirmation showing the authorization was submittedLaurie was explained that there was no authorization on file and asked her to submit a copy of an updated authorization on the proper ADA claim form. Laurie stated that the claim form was submitted correctly during the initial filling and agreed to fax over the copy for review. After review of the faxed authorization, it was the same document received by Ms***. DentaQuest called Coast Dental back and requested that the authorization be sent back on a proper ADA form to avoid delays in processing. DentaQuest emailed a copy of the correct ADA claim form to Laurie for submission. Laurie faxed the authorization back to DentaQuest on 5/01/2017. On 5/4/DentaQuest spoke with both Laurie and Ms*** to discuss the processed authorization: Lines and were changed to a more appropriate code Dand approved (fee paid changed)Lines 3,4,5,8, denied for non-covered services D2950, D2740, D2750, D9630, D9910. Line denied due to no quad/tooth/arch were submitted service D4346; this service is a non-covered service per the member’s current plan, ** *** *** *** ***Line approved for prophylaxis D1110 DentaQuest recommended Ms*** call Coast Dental and schedule an appointment for Alberto. DentaQuest also verified Ms*** has been calling the corresponding toll free number, ###-###-####. Ms*** is able to bypass the automated system requesting a member ID by pressing and speaking with a Customer Service Representative. DentaQuest apologizes for the confusion and delay in processing her request this may have caused

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.Dentaquest has still not processed payment for claimPlease ask Dentaquest to issue reimbursement for funds paid on pre-screening of braces as was approved
Regards,
Sara ***

[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 made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***
P.S. It would have been helpful to me if Denta Quest had called me, they had my phone number, to let me know what was going one. No one ever communicated this resolution to me at all. I called them again yesterday and talked to ***, who said she would recommend stop payment and issuing a new check. She was looking in my file, I am mystified as to why she did not tell me that another check had been sent. I will look forward to receiving the check, but I still believe they need a course in communication.
Thank you for your help

DentaQuest reached out to its Enrollment and Billing departments to verify if any requests for cancellation were received by the Marketplace. After further review, the Enrollment and Billing departments have cancelled your plan effective 12/31/and issued a refund in the amount of $
back to the card utilized to make the original payments. The refund was issued on 4/14/and may take a few business days to be received depending on Mr***' financial institution. DentaQuest spoke with Mr*** on 4/18/2017 to relay this information DentaQuest apologizes for the inconvenience this may have caused Mr***

[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 made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me despite most dental treatment needed not being covered by this or any other dental plan within AmeriGroupPlease delete name and other identifiable information if you plan to make this complaint public on your websiteThanks so much for quickly assisting me in getting a response from DentalQuestI greatly appreciate it
Regards,
Ruth ***

DentaQuest reprocessed claim *** for date of service 3/27/for the following: D0330, panoramic x-rayD0340, cephalometric radiographic imageD0350, 2D oral/facial photographic imageD0470, diagnostic castsPer the contractual agreement with *** *** *** *** *** ***, DentaQuest pays 25% of the usual and customary rates for these services. The provider’s office is not allowed to bill the member the remaining 75% of the fee. The provider's office was contacted and we spoke to ***, *** *** and she agreed to reimburse Ms*** the $she originally paid once she received proof we paid the claim. Attached is the provider EOB showing DentaQuest paid $75. The provider's office was contacted once again to explain the EOB is now available for review so that they may initiate the reimbursement to Ms***Ms*** also filed another appeal for the denial of authorization *** for service code D8080, comprehensive orthodontic treatment of the adolescent dentition. Please note that this appeal will be processed as a standard case and DentaQuest has calendar days to mail a written response to Ms***

Good Afternoon,
The members check was sent out via overnight mail FedEx tracking number ***
The member should have received a refund in the amount of $The actual delivery date and time was
6/30/2015, 1:43pm

[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 made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
Jonathan [redacted]

To whom it may concern,
A request for reimbursement was submitted by the member to DentaQuest on September 18, 2014, for services by Dr. [redacted] on August 7, 2014.  DentaQuest processed the request for payment and check #[redacted] was issued on October 3, 2014 in the amount of...

$124.00.  The check was mailed to the member’s current address.
 
Our records indicate we received a call from the member on October 22, 2014 inquiring about payment, she requested to speak with a supervisor, the Customer Service Representative informed the member that a supervisor was not available at the time.  The member indicated she had not received payment, she was advised DentaQuest’s standard policy indicates check traces are not issued for 30 days after a check has been issued.  However, on October 25, 2014 a check trace was issued to accommodate the member and it was confirmed the check was still outstanding.  On November 6, 2014 a stop payment was issued for check #[redacted] and a new check was issued on Friday, November 14, 2014. 
Thanks
[redacted]
Complaints & Grievances Supervisor

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

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
only one message was left from only one attempt to reach me during my working hours. I can be reached after 5pm any day of the week or on weekends
Regards,

Dear [redacted]Problem Report ID: [redacted]   DentaQuest Case #:  [redacted]Member Name and
ID: 
[redacted]Issue: Member stated she had purchased dental insurance through
DentaQuest at the end of last year and established an online account...

after
receiving an invoice in January. The member was able to successfully pay the
premiums for January and February using the online account. When the member
went to the dental office she was informed her coverage was terminated as of
1/1/2015. The member proceeded to have a dental cleaning performed at the
dental office.  Mrs. [redacted] states
that if her membership or payment had an issue the system should have flagged
or indicated that her membership was terminated when she was making her
payments.  The member is disputing an
amount of $38.00 Action/Findings:  on March 25, 2015 Mrs.
[redacted] contacted our Customer Services Department and was
informed by one of our representatives that her dental plan was termed for late
payment. The member was told to send in her payments by mail for March and
April premiums to have it re-instated.  AS
of today we have no dental claims on file for this member to indicate the
Provider office was seen at. We have attempted to contact the member with no
response on four different occasions to request a copy of the treatment plan
that was presented to her as this will serve as confirmation of the provider’s
information and DOS the member was treated on.  We have also left Voice messages indicating
our contact information so that she may return our calls. Currently, the member
is retroactively showing active as of 1/1/2015. We did not receive a call back
from the member.  Final
Resolution: Our systems show that the member has been re-instated with a retroactive
date of January 1, 2015. We will need to obtain the members treatment plan or
claim form from the office to process her charges accordingly to her plan.
Given that the member did not state what office or dentist treated her and with
no successful contact with the member to obtain required information, we will
need to close this case at this time. Should the member contact our Customer
Services Department once again, they may provide her with her current membership
status. Should you have further questions concerning this complaint, you
may contact me directly at ###-###-#### Ext. [redacted]. Sincerely,[redacted]

Good afternoon,
Please find the attached resolution letter.
thank you.

Hello,
Several attempts were made to contact the complainant at the daytime phone number provided however, no contact was made. A voice message was left for a call back in order to acquire additional member information as the subscriber in question was not identified in our...

system with the information provided.
please have complainant provide the necessary information in order to proceed with case:
Member Name:
Member ID:
DOB:
thank you,