John's Fifth Avenue Luggage

This letter is in response to the complaint submitted to Delta Dental of Virginia (DDVA) via email onDecember 28, for ID# [redacted] .Please be advised that the subscriber has an Administrative Services Only (ASO) contract through hisemployer, [redacted] According to our records, the subscriber has not yet submitted an appeal per the Summary Plan Description.Below is the information found in the subscriber's Summary Plan Description regarding Delta Dental's internalclaims review and appeal processThe subscriber should request an appeal of this matter, at which time theclaim will be reopened and fully reviewed.How to Appeal an Adverse Benefit DeterminationIf you receive an adverse benefit determination, you have the right to file an appealAn appeal must be sent tothe Claims Administrator no more than days after receipt of such a determinationTo initiate an appeal,send the Claims Administrator a letter stating why you disagree and including the following information: [redacted] Your member ID number [redacted] The claim number of the claim in question [redacted] A list of all the specific issues to be considered on appeal [redacted] Any additional dental informationClaims Administrator Corporate Address:Delta Dental of Virginia [redacted] Please contact me if you have any additional questions at [redacted] ***.Respectfully, [redacted] ***Product Filing Analyst

I have reviewed the response offer made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below The wording of the response from Delta Dental is extremely ambiguous ('The subscriber’s appeal has been overturnedHis claim for the crown and buildup will be processed within thenext 7-business days') and does not clarify is the claim will actually be 'approved' or 'paid' We are asking that Delta Dental provide clarification Regards, [redacted] ***, [redacted] ***

I have reviewed the response offer made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below Regards, [redacted] ***

I have reviewed the response offer made by the business in reference to complaint ID [redacted] , and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below Attached, please find my EOBs that is the evidence of Delta Dental having charged me twice the $deductible Regards, [redacted] ***

I have reviewed the response offer made by the business in reference to complaint ID ***, and have determined that this proposed action would not
resolve my complaint. For your reference, details of the offer I reviewed appear below
Regards,
*** ***
I tried to resolve over billing problem with Delta Dental customer servicesand all I got was denialnot-with-standing I have bank statements to prove they over-billedThus contacting them via suggested telephone access is not effective as rep on phone looks up records and quoted it was justifiedeven stating I missed the January paymenttheir records are not valid as my bank statement shows I was billed and amount posted in checking statementThus, it is apparent delta dental implements a policy that a subscriber has to be wrongand therefore no resolutions are possibleNo interest on their part to see prima facia evidence that their records are wrong

Please advise the complainant to contact the following and to attach credit card statements showing over-payment.Office of Licensure and CertificationVirginia Department of Health*** *** *** *** ***
*** ** ***
*** *** ***

I have reviewed the response offer made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Attached is a signed HIPPA release waiver.
Regards,
*** ***

I have reviewed the response offer made by the business in reference to complaint ID *** and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Our 'official' appeal letter was mailed to Delta Dental via USPS certified mail (return receipt) on 12/29/ To date, we have not received any sort of response from Delta Dental In checking USPS tracking this morning, it shows that the letter left the *** post office on 1/31/for delivery to Delta Dental, yet we have not received signature confirmation Online tracking shows the appeal letter mysteriously disappearing after delivery was attempted I find this very suspicious I am requesting that Delta Dental provide as with an email and fax to which we can immediately submit the appeal letter, since it appears there seems to be a problem with Delta Dental accepting certified mail from their customers Further, once the appeal is submitted and received via either of these methods, we are requesting that they provide us with confirmation of receipt, in writing, within hours of receipt
Please note that regardless of the status of the certified appeal letter that seems to have gone 'missing', Delta Dental has been on notice of our issue and appeal via our complaint communications through the Revdex.com AND our complaint communications through the Insurance Commissioner for the Commonwealth of Virginia So this equals two other modes of communication of our appeal that Delta Dental seems to be ignoring Shall we try pony express? Bottom line, we've made every effort to communicate our appeal to Delta Dental They are acting in bad faith by not accepting certified mail and by ignoring the copy of the complaint / appeal that was communicated via two additional methods We are adding to our resolution sought that they reimburse us for the cost of the rejected certified mail, $
Regards,
*** ***, *** * *** ***

October 15,
This
letter is in response to the complaint Delta Dental of Virginia [DDVA] received
via email on October 12,
The
complainant has coverage through her spouse’s employer, *** *** *** *** *** an Administrative Services Only [ASO]
contract
DDVA
processed the claim and applied the $deductible correctly for the D
periodontal maintenanceComplainant relates that we should have honored the
deductible satisfied with her primary carrier (DDKY)
DDVA
was unaware of another dental policy and we contacted the provider officeThe
dental office explained the primary policy was not in effect when the D
[periodontal maintenance procedure] was rendered
DDVA
was correct in applying the deductible according to the contract terms of the
spouse's policy
Please
contact me if you have any additional questions at ###-###-####
Respectfully,
*** ***
Corporate Compliance Analyst

I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.Regards,*** ***

This letter is in response to the complaint submitted to Delta Dental of Virginia (DDVA) via email on January20, for ID#***.The subscriber’s appeal has been overturnedHis claim for the crown and buildup will be processed within thenext 7-business days.Please contact me if you have any additional questions at *** * ***.Respectfully,*** ***Product Filing Analyst

RE: Revdex.com File Number:***This letter is in response to the complaint submitted to Delta Dental of Virginia (DDVA) via emailon June 26,for ID ***Please be advised that the subscriber has an Administrative Services Only (AS) contract throughher employer, *** ***.The subscriber was
sent a request for additional information needed to process the claim andDDVA has not received that informationWe recommend that Ms*** contact DDVA as soon aspossible.If you have any additional questions please contact me at 5*** extension ***.Sincerely,*** ***Product Filing Analyst

This letter is in response to the complaint submitted to Delta Dental of Virginia (DDVA) via email on January 6, for ID#***.Please be advised that the subscriber has an Administrative Services Only (ASO) contract through his employer, *** *** *** ***.The subscriber
sought treatment from a non-participating provider who did not submit x-rays for two surgical extractionsWe received the claim on December 2, and requested the X-rays on December We had no response from the provider and a second request for X-rays was sent on January 6.As soon as Delta Dental receives the requested information we will process the claim.Please contact me if you have any additional questions at *** x ***Respectfully,*** ***Product Filing Analyst

Delta Dental of Virginia is in receipt of a recent complaint for the above individual identified under ID number ***The coverage for this individual is through an Administrative Services Only policy with the employer Delta Dental of Virginia suggests that the individual work with
the group administrator concerning this complaint.Sincerely,*** ***Product Filing Analyst

This letter is in response to the complaint submitted to Delta Dental of Virginia (DDVA) via email on3/28/18, 4/10/and 4/27/for ID#***Please be advised that the policyholder had coveragewith an individual plan that was administrated by Delta Dental of Wisconsin (DDWI)The following istheir response to the complaint.Complainant’s policy went into effect on 1/1/and it was terminated per his written request on 3/13/18for a 3/31/termination.• 2/27/- DDWI was unable to draw his March payment and they sent him an email on 2/28/18• 2/28/- he sent DDWI an email stating that he attempted to update his payment informationbut was unable to do so• 3/1/- DDWI attempted to contact him via telephone, but was unsuccessful• 3/1/- DDWI sent him an email requesting that he contact them via phone if he was still havingissues updating his payment method• 3/27/- DDWI successfully drew the outstanding March premiumThere have been no additional premiums drawn and no unused premium to be refundedHecontacted DDWI’s customer service department on 3/30/and was advised of this information.DDVA’s previous replies to the Revdex.com have requested that the complainantcontact the DDWI customer service department for instructions on how to send them a copy of hisbank statements showing the overpaymentHe was also given an option to file an officialcomplaint with the Virginia Department of Health’s Office of Licensure and CertificationThecomplainant has declined both options.Sincerely,*** ***Product Filing Analyst

This letter is in response to the complaint submitted to Delta Dental of Virginia (DDVA) via email onDecember 28, 2015 for ID#[redacted].Please be advised that the subscriber has an Administrative Services Only (ASO) contract through hisemployer, [redacted]According to our records,...

the subscriber has not yet submitted an appeal per the Summary Plan Description.Below is the information found in the subscriber's Summary Plan Description regarding Delta Dental's internalclaims review and appeal process. The subscriber should request an appeal of this matter, at which time theclaim will be reopened and fully reviewed.How to Appeal an Adverse Benefit DeterminationIf you receive an adverse benefit determination, you have the right to file an appeal. An appeal must be sent tothe Claims Administrator no more than 180 days after receipt of such a determination. To initiate an appeal,send the Claims Administrator a letter stating why you disagree and including the following information:* Your member ID number* The claim number of the claim in question* A list of all the specific issues to be considered on appeal* Any additional dental informationClaims Administrator Corporate Address:Delta Dental of Virginia[redacted]Please contact me if you have any additional questions at [redacted].Respectfully,[redacted]Product Filing Analyst

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
The wording of the response from Delta Dental is extremely ambiguous ('The subscriber’s appeal has been overturned. His claim for the crown and buildup will be processed within thenext 7-10 business days') and does not clarify is the claim will actually be 'approved' or 'paid'.  We are asking that Delta Dental provide clarification.
Regards,
[redacted], [redacted] [redacted]

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]

I have reviewed the response offer made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Regards,
[redacted]

Please advise the complainant to contact our Benefit Services department at [redacted].  They can be reached M-F, 8 am to 5 pm.