DentaQuest Mid-Atlantic, Inc.

Hello,
In
addition to the Revdex.com complaint filed by the member, we also received it in our office. We responded to the member via the phone, and she requested a refund. We approved the refund for $to be mailed to the address we have on file. The refund was mailed on 6/3/and the member should have received it. We attempted to find the member a different provider, but she just wanted a refund. Our internal case number is:
The refund was requested after a phone conversation with the member took place on 5/12/15; however; refund can take up to days
Please provide my direct number to the customer if it still not resolved. My number is ###-###-####
Thank you for your time
Sincerely,
Joel G***DentaQuest
Appeals and Grievances Supervisor

Hello,
In addition to the Revdex.com complaint filed by the member, we also received it in our office. We responded to the member via the phone, and she requested a refund. We approved the refund for $to be mailed to the address we have on file. The refund was mailed on 6/3/and the
member should have received it. We attempted to find the member a different provider, but she just wanted a refund. Our internal case number is:
The refund was requested after a phone conversation with the member took place on 5/12/15; however; refund can take up to days
Please provide my direct number to the customer if it still not resolved. My number is ###-###-####
Thank you for your time
Sincerely,
Joel G***DentaQuest
Appeals and Grievances Supervisor

07/28/2014
Dear Revdex.com,DentaQuest has been made aware of a complaint filed with the Revdex.com. We have reviewed complaint ID [redacted] and have responded to the complainant personally. In addition, we are responding to the inquiry from the Better Business...

Bureau.The member stated that she purchased dental insurance from DentaOuest on the promise from the company that dentists in her area would take her policy. However, she has determined that there are not any dentists on the list she was provided that will accept the policy for adults. She stated that she has been paying premiums since March of 2014 and has been trying to find a dentist since then to no avail.She stated that she was told by a DentaQuest Customer Service Representative on July 2, 2014 that the dentist in her area just did not understand the policy. She asked if this could be explained to the dentist by DentaQuest and was informed that is not the company’s job and that it would not be cost effective to talk to the dentist. She was told it was the dentist’s responsibility to read the literature they receive.
The member stated that she asked for a refund of all premiums paid since the policy has not been beneficial to her. She stated she was informed that she could get back the last premium paid but she did have the service. She stated that she did not have service if she could not find a dentist that would utilize the policy she was promised would be accepted. At this time, the member is requesting a refund of all monies paid since March of 2014, which totals $119.20.
DentaQuest reviewed the issue and determined that this member’s plan has been in effect since March 1, 2014, however services were not used. It was determined that the member did contact several in-network DentaQuest providers but was advised that they did not accept the coverage and also didn’t accept adult members.
DentaQuest contacted [redacted] on July 23, 2014 at 11:44am. She advised that as long as we could assist her in finding a dentist in her area that can treat her, she is willing to keep the coverage. [redacted] understands that by agreeing to keep her coverage she will not receive a refund of any previous monies paid but if she chooses to terminate her coverage, it will cause her to have to restart her waiting periods,
DentaQuest has found a provider in [redacted]’s area. The provider was contacted and it was determined that they do accept her plan and are currently accepting adult patients. DentaQuest offered [redacted] assistance with scheduling the appointment; however she stated that she would contact the office herself since she would have to work on scheduling an appointment around her busy schedule. [redacted] was then provided the DentaQuest Complaints and Grievances Specialist’s contact information in case she requires further assistance with this matter.
We regret that the complainant had an unsatisfactory experience but we thank you for taking the time to share the comments with us. DentaQuest takes great care to ensure that important matters such as these are addressed appropriately and in a timely manner.Sincerely,Cynthia C
Complaints, Grievances and Appeals Supervisor

[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]
 Complaint: [redacted]
I am rejecting this response because I have still not recurved a refund.
Regards,
[redacted]

Dear Revdex.com,
I spoke directly to the member as she never received the check that should have been mailed out at the beginning of June.  There was a delay in our system and it halted the check.  The refund check was sent via [redacted] overnight and it is showing as delivered on their website.  I will follow up with the member to ensure it was delivered.
 
Thank you,
Joel G[redacted]
DentaQuest Supervisor, Appeals & Grievances

[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 Mr. G[redacted]'s information is accurate, he has followed up and I have received the check, now.
Regards,
[redacted]

Review: I have been attempting to get my son who is now 19 into see a specialist for the past two and a half weeks with no success. I have been on hold numerous times for an average of two hours each time!! All I need is a referral and they are doing everything they can to make sure this does not get done. My son needs to have a wisdom tooth removed that is impacted and painful but they could care less. They keep telling me my dentist is not doing the referral properly. I had the dentist and Dentaquest on the phone at the same time to make sure everyone was on the same page. My dentis proceeded to tell me that this is a normal occurrence with Dentaquest. They do not work for the patient. They do not care about my sons health. To top it off I've wasted over two weeks trying to gets son to a specialist and he leaves next week!!! Dentaquest is the worst company that I have ever had to deal with.Desired Settlement: To get my son into see a specialist as soon as possible!!!

Business

Response:

August 30, 2013

Revdex.com of Metro Washington, DC and Eastern Pennsylvania

1411 K St. NW, 10th Floor

Washington, DC 20005-3404

Case #: [redacted]

Member Name: [redacted]

ID:[redacted]

Issue: **. [redacted] has issued a complaint. She indicated that she has been attempting to get her son who is now 19 into see a specialist for the past two and half weeks with no success. She stated that she has been on hold numerous times for an average of two hours each time. She indicated that all she needs is a referral and she feels that Denta Quest is doing everything to ensure that her son does not have the services done. She stated that her son needs to have a wisdom tooth removed that is impacted and painful. She further stated that Denta Quest has stated that the dentist is not doing the referral properly. She indicated that she had both her dentist and Denta Quest on the phone at the same time to ensure that everyone was on the same page. She stated that her dentist told her that this is a normal occurrence with Denta Quest. She feels that Denta Quest does not work with the patient and they do not care about her son's health. She feels that she has wasted over two weeks trying to get her son to a specialist and he leaves next week.

Dear **. [redacted]

Thank you for allowing Denta Quest the opportunity to address **. [redacted]’s concerns

Denta Quest has reviewed **. [redacted]’s concern and determined the following;

[redacted] received an approved referral to be seen by an oral surgeon on January 7, 2012 due to pain in his wisdom teeth. Denta Quest received a request on January 20, 2012 to switch the member to a different provider as the member wanted to see Dr. [redacted] at the [redacted] Center for Oral Facial and Implant Surgery. The referral was inactivated and a new referral approved to Dr. [redacted] per the members request.

The member did not have the services rendered by Dr. [redacted], Denta Quest received a new request for approval of a referral on July 18, 2013, the oral surgery consult was denied on July 29, 2013 as it appeared that the services could be completed by a general dentist.

Denta Quest received a new referral request on August 9, 2013, the oral surgery consult was approved on August 12. 2013; the referral was changed on August 13, 2013 at **. [redacted]'s request as the member was moving to Gainesville.

Denta Quest reviewed the call logs between Denta Quest and **. [redacted], the following calls occurred;

7/17/2013 **. [redacted] was advised of the referral process for an Oral Surgeon.

7/18/2013 Denta Quest made a call attempt to let **. [redacted] know that [redacted] was approved to be seen by a specialist.

7/25/2013 **. [redacted] contacted Denta Quest: Denta Quest was unable to release any information due to HIPPA regulations.

7/26/2013 [redacted] called Denta Quest to grant consent for Denta Quest to speak with **. [redacted]

7/29/2013 **. [redacted] was advised that Denta Quest would need approval from the member to speak with caller in order to provide personal information,

7/30/2013 **. [redacted] gave consent to speak with his mom, **. [redacted], **. [redacted] was advised that the providers office would need to resubmit the referral request with the treating/referral provider info listed.

7/31/2013 **. [redacted] gave consent to speak with his mom, **. [redacted]. **. [redacted] was advised that the providers office would need to resubmit the referral request with the treating/referral provider info listed.

8/02/2013 **. [redacted] gave consent to speak with his mom, **. [redacted], [redacted] was advised that the providers office would need to resubmit the referral request with the treating/referral provider info listed.

8/02/2013 **. [redacted] contacted Denta Quest; Denta Quest was unable to release any information due to HIPPA regulations, **. [redacted] was advised to contact the plan as **. [redacted] eligibility has termed,

8/02/2013 **. [redacted] was advised that **. [redacted]s eligibility has termed.

8/06/2013 **. [redacted] gave consent to speak with his mom. **. [redacted]. **. [redacted] was advised that the providers office would need to resubmit the referral request with the treating/referral provider info listed,

8/08/2013 **. [redacted] gave consent to speak with his mom. **. [redacted]. **. [redacted] was advised that the providers office would need to resubmit the referral request with the treating/referral provider info listed.

8/09/2013 Denta Quest spoke with both **. [redacted] and the provider's office. The office indicated that they had submitted a referral request a week prior, however.

Denta Quest did not have, the request on file. Provider was to resubmit the request. 8/09/2013 Member authorized guardian to speak on behalf. **. [redacted] called questioning the referral pending review.

8/12/2013 Member authorized guardian to speak on behalf. **. [redacted] was told that the referral was approved and to which provider.

8/12/2013 **. [redacted] called back, indicating that she wanted a provider that could see [redacted] sooner. Several option were given to her to cal.

8/13/2013 **. [redacted] called and indicated that the Oral Surgeon was unavailable until October. Denta Quest called to see if an appointment would be available sooner, 8/16/2013 **. [redacted] called requesting a different Oral Surgeon in the Gainesville area. At this time Denta Quest does not have a different provider option for **. [redacted] in the Gainesville area.

Action/final resolution:

Denta Quest has reviewed **. [redacted]’s concerns, looking both at **. [redacted] call history, claim history and referral history and it appeal's that **. [redacted] has received approval multiple times to have a referral with an Oral Surgeon since the original approval given in January of 2012.

Denta Quest will continue to work with the member to ensure that he is able to receive the needed services, Should **. [redacted] need to speak with someone directly, she may contact [redacted]. Complaints and 0rieva.net! Specialist at [redacted] to address any further concerns.

Denta Quest takes great care to ensure that important matters such as these are addressed appropriately and in a timely manner. However, it appears that based on **. [redacted]'s concerns we have not met that standard,

I apologize to **. [redacted] for any inconvenience that occurred based on this situation and hope that she will contact me directly with any additional concerns that she may have about the level of service she received from Denta Quest Customer Care representatives.

Sincerely,

Review: I have purchased dental insurance from this company on the promise from the company that dentist in this area will take the policy. However, no dentist in the area that is on a list provided by the company will take the policy for adults. I have been paying my premium since March of 2014 and I have been trying to find a dentist from the list since then to no avail. I was told by a customer service rep on July 2, 2014 the dentist in the area just did not understand the policy. I asked could they explain it to them and I was informed it was not the company's job and it would not be cost effective to talk to the dentist. It was the dentist responsibility to read the literature they received. I asked for a refund of all premiums paid because I have paid for a policy that has not been beneficial to me. I was informed I could get back the last premium paid but I had the service. I had no service if I could not find a dentist to utilize the policy I was promised would be accepted.Desired Settlement: I would like a refund of all monies paid since March 2014 a total of $119.20. The policy has not been beneficial to me no dentist in the area will accept the policy after they are on a 5 page list. My benefit period will have to start over because of the deceptive practices of Dentaquest involving this dental insurance. I could have taken the money I paid for a policy and paid to have my teeth cleaned.

Business

Response:

07/28/2014Dear Revdex.com,DentaQuest has been made aware of a complaint filed with the Revdex.com. We have reviewed complaint ID [redacted] and have responded to the complainant personally. In addition, we are responding to the inquiry from the Revdex.com.The member stated that she purchased dental insurance from DentaOuest on the promise from the company that dentists in her area would take her policy. However, she has determined that there are not any dentists on the list she was provided that will accept the policy for adults. She stated that she has been paying premiums since March of 2014 and has been trying to find a dentist since then to no avail.She stated that she was told by a DentaQuest Customer Service Representative on July 2, 2014 that the dentist in her area just did not understand the policy. She asked if this could be explained to the dentist by DentaQuest and was informed that is not the company’s job and that it would not be cost effective to talk to the dentist. She was told it was the dentist’s responsibility to read the literature they receive.The member stated that she asked for a refund of all premiums paid since the policy has not been beneficial to her. She stated she was informed that she could get back the last premium paid but she did have the service. She stated that she did not have service if she could not find a dentist that would utilize the policy she was promised would be accepted. At this time, the member is requesting a refund of all monies paid since March of 2014, which totals $119.20.DentaQuest reviewed the issue and determined that this member’s plan has been in effect since March 1, 2014, however services were not used. It was determined that the member did contact several in-network DentaQuest providers but was advised that they did not accept the coverage and also didn’t accept adult members.DentaQuest contacted [redacted] on July 23, 2014 at 11:44am. She advised that as long as we could assist her in finding a dentist in her area that can treat her, she is willing to keep the coverage. [redacted] understands that by agreeing to keep her coverage she will not receive a refund of any previous monies paid but if she chooses to terminate her coverage, it will cause her to have to restart her waiting periods,DentaQuest has found a provider in [redacted]’s area. The provider was contacted and it was determined that they do accept her plan and are currently accepting adult patients. DentaQuest offered [redacted] assistance with scheduling the appointment; however she stated that she would contact the office herself since she would have to work on scheduling an appointment around her busy schedule. [redacted] was then provided the DentaQuest Complaints and Grievances Specialist’s contact information in case she requires further assistance with this matter.We regret that the complainant had an unsatisfactory experience but we thank you for taking the time to share the comments with us. DentaQuest takes great care to ensure that important matters such as these are addressed appropriately and in a timely manner.Sincerely,Cynthia CComplaints, Grievances and Appeals Supervisor