Healthplex, Inc.

Have had HBealthplex for past 11 years with no real problem until now. My policy runs from 4/1/20 until 3/31/1 and allows for two dental exams per contract year. Had first on 7/2/20 at Eastern Dental in Northfield NJ and was scheduled for 2nd on 1/5/21. Received call fromEastern Dental on 12/29/20 saying they had to reschedule to 7/22/21., because they had only ONE dentist working and were short staffed. This July date is 5 months after my contract policy expires. I then called Healthplex and explained the situation ands as told I could change locations to another Eastern Dental ( 40miles away) but would have to have Healthplex make the change, then call for appointments etc all the time not knowing whether the other location had enough dentists. This is an absurd situation and is a shame because both my wife and I have been generally pleased for the past 11 years. I realize that the covoid 19 situation is affecting dental services but I believed I should receive a partial refund for non service if they can't honor their contract. I also asked if I kept the JUlY 2021 appointment would Healthplex pay as it was past the expiration date of my policy and of course was told NO. Stuck between a rock and a hard place!

Revdex.com:At this time, my complaint, ID *** regarding Healthplex, Inchas been resolved
(By clicking "OK", your complaint will be closed as Resolved.)
Sincerely,*** ***

Misdiagnosed problem with my carI paid $for repairs and car not fixedThe car needs new head gasket which will require a lot of same labor I just paid forThey changed water pump & missed a blown head gasket

Healthplex. Their dentists, with few exception, are evil. What kind of dentist wants to extract a very good tooth for no reason (I refused of course). What kind of dentist removes a mercury filling, drops it into your throat, stops working and instructs you to swallow it? Those are supposed to be disposed of as hazardous waste. What kind of office has an x-ray machine that breaks so that you must make another appointment for x-rays when it is an hour trip for you to the office. Then inflicts as much pain as possible with the novocain needle directly into a nerve, after refusing your request to forego the novocain. That is criminal intent or negligence. What kind of dentist refuses to repair the most basic filling that has fallen out and is a glaring dental problem, then refuses to treat you at all and sends you to another office. They should not have license to practice. These are evil people. Avoid this insurance and their dentists if you value your teeth and your health.

Review: Our 12 year old daughter [redacted] was missing a tooth and when she was 12 we were advised by a Healthplex orthodontist (Dr. Kellyn H[redacted]) that she should begin orthodontic treatment immediately and that upon completion of that treatment, about 2 years later that she would need to have oral surgery and an implanted tooth.

Healthplex reviewed and approved her orthodontic plan and paid for her orthodontic treatment.

It is important to note that because [redacted] was missing a tooth [redacted]’s orthodontic treatment spread her teeth and left her with a deliberate gap in her teeth. Immediately upon completion of her orthodontic treatment the plan was for her to have oral surgery and an implanted tooth.

If this was not done immediately upon completion of the orthodontic work then the gap in her mouth that had been created by the orthodontic work would close enough that the oral surgeon would not be able to start and complete the process of implanting a tooth.

On 6/**/2015 Healthplex denied the claim stating the [redacted] was too young for the procedure.

We called Healthplex and were advised that we simply needed to explain the situation to the grievance department and the claim would be processed

On 07/**/2015 our daughter was set up for her oral surgery and she had her surgery with a Healthplex doctor ([redacted]).

We then sent a letter to the grievance department as advised and the Healthplex oral surgeon ([redacted]) also sent a letter to Healthplex explaining that the medically appropriate time for [redacted] to have the Surgery was 07/**/2015.

On 09/**/2015 Healthplex again denied the claim.

I then called Healthplex again and was told that they would reevaluate the claim.

By this Point I laid out and paid $2000 to [redacted] (the Healthplex Doctor) for the procedure.

On 10/*/2015 I received another explanation of benefits that was updated and stated that there may be copays for the procedure.

I have not received reimbursement for the $2000 I laid out to the Healthplex doctor and I would like Healthplex to send me a reimbursement check for the $2000

Thank YouDesired Settlement: I want Healthplex to refund to me the $2000 that I paid To the Healthplex doctor.

Consumer

Response:

At this time, I have been contacted directly by Healthplex, Inc. regarding complaint ID [redacted], however my complaint has NOT been resolved becauseI received a letter from healthplex dated Oct *, 2015 stating that I would receive an explanation of benifets under separate cover. As of today Nov **, 2015 I have not received anything else from healthplex. As of today when I view the claim on the Healthplex website it does not indicate that they have paid me any money.

In order for the Revdex.com to appropriately process your response, you MUST answer the question above.

Sincerely,

Business

Response:

Good Afternoon. Please see the attached response that was sent to the

NYS Department of Financial Services in regards to [redacted]s

complaint. A copy of the applicable Explanation of Benefits is also

attached. Patient copayments apply to this service in lieu of payment

from his self-funded plan. Duplicate copies of the Explanation of

Benefits were mailed to [redacted] today per his request. Thank you.Erica P[redacted]| Manager,

Quality Management Department| P: ###-###-#### | F: ###-###-#### |E: [redacted]Healthplex, Inc. [redacted] | [redacted]Healthplex is committed to providing access to

high quality affordable dental care and to improving the oral health of our

community. Our comprehensive, innovative solutions serve to build trust

and deliver value.Confidentiality

Notice: Confidential and Protected Health Information may be enclosed. It is

being sent to you after appropriate authorization from the patient or under

circumstances that do not require authorization. You, the recipient, are

obligated to maintain it in a safe, secure and confidential manner pursuant to

federal and state law. If you are not the intended recipient, or the employee

or agent responsible to deliver it to the intended recipient, you are hereby

notified that any disclosure, copying or distributing of this information is

strictly prohibited. If you have received this transmission in error, please

notify the sender immediately to arrange for the return or destruction of these

documents.

Review: Jan 2013 I signed up for a membership. I decided that I would probably never use it, cancelled the membership and was issued a refund check in April 2013. On January [redacted], 2014 a debit of $108.90 is held on my bank account from Healthplex of [redacted]. When I called about this (almost and hour of phone conversations) I was first told that they do not hold money, and it was my bank holding money. I was told I need my bank to call Healthplex. When I called my bank they said they would not be able to just hold money against my account for whatever reason they wanted, I requested they call Healthplex to confirm that it was in fact Healthplex holding the money, and to try to release it. But my bank is not legally allowed to call unless healthplex calls them and requests information. Just a big run around. Apparently an error in accounts receivable that they never took me off of auto renewal when I canceled my membership. Now I will now receive a refund until it clears from my account, processes through them, 7-10 business days later they may issue me a check if they find it an invalid debit. WHAT??? Who's is going to buy food for my family or pay the overdraft charges on the utility bills I wrote that will now bounce!!??Desired Settlement: Desired would be that they realize their error now and retract the charge on my account so my checks don't bounce and I can buy food for my family. I'll have my kids call them later when they are hungry.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved. Once the comptroller of the company viewed my email I received a call immediately. She reimbursed me for the overdraft fee incurred from a bounced check on a bill I sent out, and reversed the charges taken from my account.

Sincerely,

Review: I called HealthPlex for a follow-up for the dental ID cards. I paid in full the $264.00 as requested in the welcome letter. When I didn't receive my cards, I grew suspicious. I saw that money had been taken from my bank account. The transaction occurred on April *, 2014. The transaction has been posted on April *, 2014.

When I called HealthPlex, I spoke with [redacted] at 1:38 pm on May *, 2014. She told me to contact Emblem since they are my provider. I told her that the transaction came from HealthPlex and HealthPlex took my money. She told me I needed to pay another $134.00 for dental insurance. I told her that I paid $264.00 already. [redacted] said she doesn't see the payment. I told her where did the money go? She said she doesn't know. When I kept asking her, [redacted] told me to call Emblem. It seems like she didn't want to deal with the issue.

I called Emblem and I spoke with [redacted] at 1:50 pm on May *, 2014. [redacted] told me he can't do anything about it. He told me to call New York Market Place. I called the New York Market Place and I spoke with [redacted] at 4:24pm. I told her that HealthPlex took my money and didn't give me any ID cards for the plan. She said she spoke with her [redacted] who told her to open a complaint against HealthPlex.

I told her I lost $264.00.Desired Settlement: I would for them to refund me the total amount of $264.00.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me and the matter has been resolved.

I contacted HealthPlex again. I spoke to [redacted] from the accounting dept. The company received my payment. [redacted] said she will send out the ID cards today.

Thank you for your immediate response.

Sincerely,

Review: I have TWO pending claims submitted on October **, 2014 that have not been processed by Healthplex Dental. I also submitted predetermination paperwork for the claims on 7/*/14. Healthplex is to pay secondary to [redacted] Dental, my primary dental insurance. They have not done so, even though I have submitted the proper claiim forms. evidence of my payment on the claims, dental records, periodontal charting and COBs from [redacted] Dental (who pays the provider on a capitated basis). I have called numerous times on the claims and have emailed. I was told that the claims would be processed and checks cut by today (2/*/15) and nothing has been done and the claims are still pending.

I received another request for materials already submitted in scanned copy this week and called again to speak with a [redacted]. [redacted] the [redacted] I spoke with on 2/*/15, stated that nothing had been done on the TWO pending claims and that it would take another 15 business days. He declined to give me any name of a person at Healthplex to escalate my complaint to.Desired Settlement: I want them to escalate the processing of these claims and send me a check by 2/**.

Consumer

Response:

At this time, my complaint, ID [redacted] regarding Healthplex, Inc. has been resolved.

(By clicking "OK", your complaint will be closed as Resolved.)

Sincerely,[redacted]