United Concordia Companies, Inc.

Review: United Concordia has put me through the wringer for a $295 claim for dental work done December 12. 2013. They keep making more requirements, and act like myself and the dental office are trying to get away with something. They keep finding more and more reasons not to pay. The dentist sent them the claim form two times by mail. United Concordia claims they didnt receive either of them. It seems unlikely that the postal service is having a specific issue getting mail to this particular address. They werent returned to the dentist by the USPS. When we couldnt get the completed claim forms to them by mail, the dental assistant wanted to FAX the forms. UC person says they cant do FAXes (unlike the majority of the business world). The dental office was finally able to get a form to them. But UC wouldnt take the form that the dentist usually uses, they wanted another form. I have been with this dentist a long time and had other insurance carriers. As with many of these issues, they hadnt occurred with other insurance carriers. Never had an issue with standard form before. The dental office sent it in on the form that United Concordia demanded they use. Well over a month after the dental office had sent the form that UC required, I get an explanation of benefits denying the claim due to a wrong form. Then they said they needed X-Rays. My dentist sent X-rays. I called to see if they were finally going to pay and I was told by their representative that my dentist had sent bitewing X-rays and that type of X-Ray wasnt acceptable. My dental office says they sent what UC had asked for. United Concordias attitude on this is one of suspicion, and with each new hurdle they put in the way, you still havent proved to them that you had a dental issue and had it taken care of by a dental professional. What is the thinking behind this? Are people going to dentists to have work done when they dont need to? Is there an issue out there with people having unnecessary dental work, and dentists colluding with them to get this un-needed work done? Of course not. I wouldnt go to a dentist to get a crown repaired if I didnt have an issue. I think this is standard procedure for this company. You hear of insurance companies denying every 10th or so claim as part of their business model. They make it so difficult to get paid that most people give up. The insurance company keeps that money and this increases their profit. After this experience, I completely believe that this occurs and that this is part of United Concordias policy. I think the United Concordia should stop with the obstacle course and pay my legitimate claim.Desired Settlement: I would like them to pay my legitimate dental claim

Business

Response:

May 14, 2014[redacted]:I am writing in response to a complaint submitted on May 4, 2014 by [redacted] regarding the denial for a prefabricated post and core on Tooth Number 20 provided on date of service December 10, 2013. We received your email on May 5, 2014.**. [redacted] is covered as the member under the [redacted] ([redacted]) effective January 1, 2011, under Group Number [redacted]. This program is offered by the U.S. Office of Personnel Management (OPM). United Concordia administers and underwrites [redacted] for OPM. As a Federal plan, [redacted] is not subject to state insurance laws. As a courtesy, I am providing you with the following information.All claims are processed according to the terms of the subscriber’s contract and the information reported on the claim form. United Concordia Dental contracts include provisions requiring input from our Dentist Advisors to determine financial responsibility. We are responsible for ensuring that payment is appropriate for the care our subscribers receive. Our dental review program fulfills this responsibility.United Concordia Dentist Advisors review cases by studying claims history, reports, correspondence and diagnostic information such as radiographs. Following the review the claim is processed based on the Advisor’s opinion and the subscriber’s contract.On January 27, 2014, we received claim number [redacted] for date of service December 10, 2013, for a prefabricated post and core on Tooth Number 20. The Dental Claims Department recognized that this non-participating provider ([redacted]. [redacted], DMD) submitted services on an unacceptable dental claim form and sent a letter to Dr. [redacted] explaining how to obtain an acceptable claim form. A copy of this letter is enclosed for your reference.The provider community was informed of updates to the claim form on the American Dental Association website (www.ada.org), United Concordia’s website (www.ucci.com1), the ADANews. and United Concordia’s newsletter the Connection.On March 17, 2014, we received claim number [redacted] for a prefabricated post and core on Tooth Number 20. On March 24, 2014, a letter was sent to Dr. [redacted] requesting a pretreatment radiograph of Tooth Number 20 (prior to crown preparation/insertion) of the completed root canal showing the entire apices. The claim denied because we did not receive the requested information within the allotted timeframe. A copy of this letter is enclosed for your reference.On March 26, 2014, **. [redacted] called United Concordia questioning the status of his claim for date of service December 10, 2013, and was advised we needed an X-ray showing the apices.I spoke to [redacted] and Dr. [redacted] on May 14, 2014, and explained what was required for a second review and where to send the information.If I may be of further assistance, please contact me.

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

I want United Concordia to finally pay what they owe for a procedure I had done in December 2013. This company has shown a clear pattern of avoidance of payment. They have spent so much of my time and my dentist’s and kept asking for more evidence, information to be filed on different forms, that my dentist has threatened to report them to the Ohio Department of Insurance. I hope that he does. They have created so many hoops to jump through, and made the process as difficult as possible, clearly avoid paying for a simple crown. Nothing we send them is good enough, and they make the process as difficult as they can. Just one example of many; they will not accept FAXed information from my dentist. Everyone and their brother has a FAX machine, and can send and receive FAXes. They are built into even inexpensive printers. A large part of this company’s business is (or should be) communicating with their customers. Yet, when my dentist wanted to FAX them information, when they said they had not received the 2 claims they had sent by mail, a UC rep, said “We WILL NOT accept FAXed information”. How is this good in any way for the clients and providers who try to send them information? It does however make the process of getting claims processed more slow and difficult, which would result in more money for the insurance company; they can keep the money in their bank account longer earning interest and making the process more difficult will mean that more people give up on getting their claims paid, which equals more money in the insurance company’s ‘pockets. As we come up on almost of year of haggling with United Concordia, my Dentist has told me that he met their latest demands back in June, sent what they asked for this time - a different X-ray than the first one he sent, and a narrative of what was done and why. So, I get an explanation of benefits from United Concordia dated August, again denying payment, which vaguely states “additional information was required to process these services. The provider should resubmit these services….” This is the most evasive, slippery, unethical insurance company I have ever dealt with.

Quit giving myself and the dental provider the run around, and putting up hurdles to payment, and pay this legitimate claim.

Regards,

Business

Response:

September 18, 2014[redacted]:I am writing in response to a complaint submitted by [redacted] regarding the denial for a prefabricated post and core on Tooth Number 20 for date of service December 10, 2013. We received your email on September 10, 2014.I searched **. [redacted]’s file per his indication about information sent to us in June, 2014, and found a letter attached to a claimform. I copied the letter and radiograph and had this information reviewed by one of our Dental Advisors. They approved the service and a payment of $63.60 is being sent to **. [redacted] on Friday, September 19, 2014.If I may be of further assistance, please contact me at[redacted]Sincerely,

Review: Below is copy of the email I sent them on 14 MAR 2013. My wife has been going back and forth with these people for over a year now. I do not understand what the problem is and it appears they have no intention in paying me what is due to me as this company according to their site has not responed to my email. My wife has been contacting you with no resolve to my knowledge. I seeon your site [redacted] that you will not be accepting mail after 10 August 2013. My son [redacted] has had orthodontic work and I have paid 100% of all fees. My name is [redacted] and I am not going to send you my SSN to a .com email that will not receive encrypted. Due to the inefficiency of your services(United Concordia) I cannot get any of the fees due for orthodontics from the current Dental Program to me until you have fulfilled your obligation.Your full cooperation would be much appreciated as I know for a fact that my wife has contacted and provided your company with all needed informationalong with the "approved" orthodontics.Desired Settlement: United Concordia should pay me what is due according to the orthodontics coverage while they had the contract with the US Military.

Business

Response:

Please see attached response and HIPPA form. Please sign and return the HIPPA form. Thank you.

Consumer

Response:

[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]

There is no need for a HIPPA or SSN for this to be looked into as this just proves the continual type of change in additional information needed to close this claim. This is the reason that tricare changed dental coverage providers.

Review: [redacted]

I am rejecting this response because:

Regards,

Review: United concordia refused to provide coverage for a crown when the tooth was fractured at the cusp and clearly covered by the insurance policy, the medical/dental professional appealed the ruling and tried to correct the misinformation the concordia dental advisor was using as an excuse to deny the claim - that the tooth was only cracked (it was clearly fractured and loose) and that a filling would work ( the tooth already had a filling and was fractured and moving at the cusp) only a crown would work and it was covered under the conditions of the policy. United Concordia uses anonymous "dental advisors" in these bogus diagnosis and I have reason to believe the dental advisors giving these diagnosis are not licensed to practice dentistry in MD and thus are acting unlawfully.Desired Settlement: honor the insurance policy and contract and pay the claim to the service provider

Consumer

Response:

--------- Forwarded message ----------

From: Revdex.com of Metro Washington DC <[email protected]>

Date: Wed, Sep 3, 2014 at 10:36 AM

Subject: Fwd: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted].

To: [redacted] <[redacted]>

---------- Forwarded message ----------

From: [redacted]>

Date: Tue, Sep 2, 2014 at 6:06 PM

Subject: Re: You have a new message from the Revdex.com of Metro Washington DC & Eastern Pennsylvania in regards to your complaint #[redacted].

To: [email protected]

I did get a letter from them today saying they are going to pay the dental claim.

Review: After being contacted by a collection agency, I was made aware that my ex-wife has filed a claim for dental insurance after our divorce date and it was processed. After accounting, UCCI recognized that she was no longer a beneficiary of benefits and billed both her and myself. I have went through countless steps to try and resolve the issue and tried on at least 5 separate occasions to speak to someone. I was directed to an e-mail address in which I was sent the same exact form letter on 2 different occasions stating that I am responsible. I refuse to be held responsible for payment in that I am/was no longer married to my ex-wife, have no control over whom she lists as her insurance, did not receive dental care services, and was not given any funds from UCCI. Funds were paid directly to the dental office on her behalf. UCCI insists on not taking a personal interest in this as is evidenced by their lack of human interaction and use of form letters to repeat their false claim. The lack of professionalism and customer service is appalling. I refuse to pay for a bill which is not mine, nor go to any added expense to help UCCI collect from the proper party responsible. Repeated efforts to persuade the divorce judge for an order, have been fruitless since it is his ruling that it does not meet his jurisdiction requirements. It happened after the divorce and therefor can not be ruled upon by him under that premise. I have contacted multiple service agencies to gain help in resolving the issue to no avail. I have filed a fraudulent claim case and have received no response from that department of UCCI.Desired Settlement: In regards to this claim, UCCI will pull all collection activities in my name. They will reverse anything negative on any file, credit report, or paperwork that is associated with my name both internally and externally. UCCI will cease collection activities towards me. UCCI should write an apology letter for taking my time and attention for well over 1.5 years in trying to resolve this matter and their inattentiveness and unwillingness to fix a problem. UCCI should put in place a process that allows for others with these same types of issues, an effective avenue to correct. UCCI should hold accountable and begin collection activities on [redacted] or [redacted] if they deem necessary. UCCI should provide documentation as to statement of account that all collection activity has been stopped and all account balances in my name reflects $0.00.

Business

Response:

Due to the 1974 Federal Privacy Act, we are not able to discuss this with you, without specific permission from the member. We have responded to the member.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: I am not asking the business to discuss any medical history. This is purely a billing issue and a lack of attention on UCCI's part. Investigation is required, not form letters and smoke screens. I urge UCCI to do the work, and respond accordingly.

Regards,

Business

Response:

We will respond directly to the member. Thank you for forwarding this information to us for review.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: The business provided no response. Required document is submitted as attachment.

Regards,

Business

Response:

The patient, the exwife, had dental services provided and paid when she was still covered under the dental plan. We later received information from the military indicating that her coverage should have cancelled prior to the date of service that was paid.

We sent a refund request to the patient and also notified SSGT [redacted] of this refund request. After a period of sixty (60) days if the refund has not been satisfied, the refund falls back on the policy holder. That is what happened in this instance.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: As stated in my original complaint, I did not receive services, I did not receive any funds, I removed the patient from DEERS in a timely fashion. It is not my fault that the claim was paid and regardless, I still have nothing to do with these services or funds. I recommend UCCI requests subject funds from the dental office where they were paid. My conversation with the dental office states that it would return any funds improperly paid, but I can not request that since it is not my account. I have no access to that dental account due to patient privacy laws. I am not understanding how UCCI can bill someone (me) that has nothing to do with anything (no access to account, no funds received, no relationship) at the time services were rendered. Request UCCI responder address the issue, not restate policy which is not applicable.

Regards,

Business

Response:

If the dental office is willing to send back the payment that was issued to them, please provide them with the following address: UCCI, Cashier. PO Box 69402, Harrisburg, PA 17106. Please ask them to reference the sponsor's social security number so it may be properly applied to the refuind request.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: As stated before, the dentist office will not allow me to request anything since I am not the actual patient. The request must come from UCCI as per conversation with the dentist office. The payment never came from me and thus can not be requested back by me. This has all been said before, if your company would pay closer attention to the details of this complaint it would alleviate months of hassle and multiple requests for the same information and a result.

Regards,

Business

Response:

The refund is correct and remains in effect. We have offered you the opportunity to have the dental office submit the refund. You may also wish to contact your ex wife concerning this issue. We will not respond to this again.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: UCCI refuses to put forth any effort to even thoroughly read messages, much less resolve their own issue. They failed to exercise due diligence in providing payment for a fraud issue. They failed to accept a fraud claim on this payment. They failed to request money from those that they paid it to or for. What they insist on doing is requesting payment from someone that has no business in this matter and continuing illegal collection practices. UCCI has effectively refused to communicate with me through any means other than a Revdex.com complaint. When responding to Revdex.com complaints they continue to have a standard auto response and fails to realize any mistake on their part. Probably the reason they no longer have the government contract for dental care anymore.

Disgusted and appalled,

Review: I’m writing about a claim that I spoke to my dental insurance company about before I had the dental work at the dental office conducted on December 27, 2013. I am appealing the decision to not pay this claim because I was told that I had the benefits to cover this claim. I was supposed to be covered for the amount of $1,500, which I actually used less than that amount expecting to of course not have a bill. The work that was started at that time was to remove old crowns and replace with new crowns as there was a lot of decay after my most recent pregnancy. I was told by customer service that I would be covered after my pregnancy in October 2012, for the amount of $1,500 dollars. So, after calling on more than several occasions to verify what was said, to me of course I believe the bill was going to be paid. All to find out at my most recent dentist visits to place crowns in my mouth, that I owed the doctor’s office $1,667.00. All I can say is I was floored because I verified the information and I really could not believe it, truly I was upset. So, at the time of service on April 24, 2014, I called customer service to inquire why my bill had not been paid. They stated that I was not given $1,500 for each period but $750 for half year, as was requested by my employer. I stated that to customer service that I was not told that and that I wanted them to verify it. They stated that they were unable to locate the information but that they did see where I had called more than several times about my insurance policy. I was very frustrated and asked to speak to a supervisor whom told me basically the same thing and when asked what is name was he only gave me his first name and refused to give me his last name. I was very upset that an insurance company that is automatically paid from my check monthly was so incompetent with giving the correct information, along with poor customer service. I was not even sure if they were joking or not by their responses. I’m truly upset that I was placed into a position that after service my insurance company placed me in a position where I was not able to afford the work completed. I was completely embarrassed because of this situation. My doctor’s office verified benefits and so did I. I really don’t think that I should be penalized for someone else’s mistake. Also, during the year of 2012, I really could not get the work completed at that time because I was pregnant and I was advised that because of pregnancy the dental work would have to wait until after delivery of my baby. I was told by that insurance company that I would be covered because I had not used my benefits. At this time, have three children so I’m cautious of my expenses and that was the reason for the calls to my insurance company to verify coverage. I truly can’t afford to pay a bill like that and I don’t feel that I should be held responsible because of someone’s mistake or misleading information. This year I have $1,500 dollar’s each half of year and benefits have always been that way in the present and past. And since I know this information and do not want to get stuck with a bill wouldn’t it seem that I could have waited basically a week later to have this service completed. I was told that I would lose my benefits if I did not use them at that point and the amount told to me was $1500. I would appreciate any assistance with this situation as I have not plan for anything like this to happen. I believe that once reviewed it will be verified that I’m being truthful in being guided in the wrong direction. Also, I would like to add that on my Dental benefits of Explanation it reports that it was a duplicate service reported and processed on claim number: 14009367609, which this service only happen one time, so I’m really confused about what is going on. I would like all billing or service completed through my doctor’s office in the month of December to be reviewed as it is possible that may be there is a billing error. I was seen for a cleaning and then service for 3 crowns. Please help me with this matter.Desired Settlement: I feel in a much as I contacted them to verify service that it should be honored in as much as that is what I was told. My benefits have always been $1500 and I not really sure for the change of benefits but I have always had PPO plan to protect against having a large co-pays. I thought that part of the reason for having a number to contact my dental insurance is so that I can find out what benefits I have to prevent situations such as this. I really felt that it was truly unfair and that the customer service in general was terrible because I'm consumer I have the right to know whom I speaking too in case I need a reference. I was really surprised. If you are paying to have a service they should a least be considerate enough to be polite and not have a nasty tone while doing there job.

Business

Response:

May 16, 2014Dear [redacted]:I am responding to your e-mail dated May , 2013, questioning services provided on December 27, 2013, that denied due to exceeding the maximum.We have not received federally required HIPAA authorization from the complainant to release protected health information concerning this account. Therefore, we can only provide a general response to this complaint.[redacted] is enrolled as the subscriber under a Fee For Service group dental plan through the State of Maryland. Her coverage is effective October 16, 2006, under Group Number [redacted].The State of Maryland had a short plan year covering July 1 to December 31, 2013. Prior to the groups open enrollment period from April 16 to April 30, 2013, the State of Maryland notified their employees that they should read the Open Enrollment materials mailed to their home or provided by their Agency Benefits Coordinator to learn how this short plan year affects their benefits. They provided their website, www.dbm.maryland.govbenefits, which states that the maximum was prorated for this short plan year. The PPO Schedule of Benefits they provided lists the maximum per member during the period of July 1 to December 31, 2013, as 750.00, excluding Class I services for diagnostic and preventative services.These benefits were available to the subscriber or provider prior to treatment on our Automated Voice Response telephone system at ###-###-####, on our website at www.ucci.com, or by a Dental Customer Service Representative at ###-###-####. We document all telephone calls and correspondence received. There is no record that we gave incorrect benefits prior to treatment or that we stated these procedures would be paid.According to our records, we paid 750.00 for dental services provided for [redacted] from July 1, 2013 to December 31, 2013 that were not Class I services. The dental services provided on December 27, 2013 were not Class I services. Therefore, no additional payment can be made for the services provided on December 27, 2013, that denied correctly as exceeding the maximum.I have enclosed a HIPAA authorization form for you to return with the subscribers signature if you need additional information. I have also enclosed a copy of information the state provided their members concerning this maximum prior to July 1, 2013.If [redacted] has additional questions, she may call Dental Customer Service at ###-###-####.Sincerely,

Review: On 1/24/13 they approved a dental bridge to be installed in my mouth and so I had the work done and then they didn't pay for the dental service. They had x-rays and all the needed information when they approved the service.Desired Settlement: I want them to pay for the service they approved.

Business

Response:

October 03, 2013

The Revdex.com [redacted]

Complainant: [redacted] Inquiry Number: [redacted] Revdex.com ID Number: [redacted] United Concordia Insurance Companies

Dear **. [redacted]:

I am responding to your e-mail received September 26, 2013, concerning the denial of a fixed partial denture for **. [redacted].

We have not received federally required HIPAA authorization from the complainant to release protected health information concerning this account. Therefore, we can only provide a general response to this complaint. This group dental plan is fully insured under United Concordia Insurance Companies.

In the detailed benefits report, under the Category of Prosthetic services, the replacement of a fixed partial denture by a new dentures is eligible if satisfactory evidence is presented that the existing dentures was inserted at least five years prior to the replacement and is not serviceable and cannot be made serviceable. This detailed benefits report is available to the member online at www.ucci.com and also by fax or mail via a Dental Customer Service representative or through the Interactive Voice Response (IVR).

In the Group Certificate of Coverage, on page 3 of the Schedule of Exclusions and Limitations, Item 10, states:

• Replacement of natural tooth/teeth in an arch - not within five years of a fixed partial dentures, full denture of partial removable denture

We received a predetermination for a fixed partial denture for Tooth Numbers 09,10, and 11. The provider filed the predetermination and did not indicate that it was for the replacement of an existing partial denture. The predetermination was approved and a Dental Predetermination Notification was sent to **. [redacted] and the provider advising that the services had been approved. However, all predeterminations have a disclosure statement in which the member and provider are advised of the following: "The approved amount is subject to the terms of the beneficiary's coverage in effect on the date of receipt and may change if the contract or the proposed treatment plan changes. "

After the predetermination had been approved, the provider submitted a claim for the replacement of an existing fixed partial denture for Tooth Numbers 09, 10 and 11. On the claim the provider indicated the existing denture had been in place as of April 16, 2009. Based on the this date, the existing partial denture would not be eligible for replacement prior to April 26, 2014, and the claim for the new denture was denied correctly because of the one in five year replacement frequency.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

The preapproval was granted for the fixing of my teeth. It is not my fault that United Concordia failed to look over their documents and just went ahead and approved the claim. I should not have to pay for something that I was pre approved for and if they do not check their records it should not be my consequence. My dentist has sent over proof that I have not had a similar procedure done and also wrote them a letter saying that it should be covered. My dentist has been in the business for many years and has said he has never had such trouble from and an insurance company as he has with United Concordia. Because of the late fees, time spent, and time that my dentist has now spent on this case I would really just like for United Concordia to pay for what they had pre approved.

The definition of a "similar procedure" to the insurance company and dentist may be two different things which is not clearly detailed in the insurance. Also, if United Concordia had questions on it, that should have been brought up before the procedure was completed.

Regards,

Review: Due to a delay in their processing of my electronic payments my policy was terminated, despite them having my payment. I was treated very rudely and was told I was not able to reinstate the policy thus my insurance policy was cancelled. They held two of my payment for months, despite multiple calls from my bank. I called them at least once a week for 4 months asking for my money to be returned to me. I had multiple hour or longer conference calls with [redacted] and two different departments at my bank. The [redacted] operators were very reluctant to allow me to escalate to a supervisor and told me if I left messages the supervisors would return my calls which they did not. When I was finally able to reach the supervisors they assured me my refund was in the mail multiple times when it wasn't. They held onto my money for four months and at the same turned me over for collections. I called them multiple times requesting to be removed from collections agency as not only did I not owe them money, they owed me money. Anna, a supervisor at [redacted], told me during one of my calls that she had removed me from their collection list which was not true. Still receiving collection notices I called back and was told that I would have to contact the collections agency directly because they couldn't tell me which of the multiple collection services they use. When I called the collection agency multiple times [they laughed that I was told something so obviously incorrect] I was told that it would have to be corrected by [redacted]. I have working on resolving this issue, which never should have happened, since June. It is still unresolved.Desired Settlement: A negative Revdex.com rating and my credit restored.

Business

Response:

October 16, 2014Dear [redacted]:I am writing in response to your letter dated October 14, 2014, concerning [redacted]. We received this letter on October 14, 2014.[redacted] indicates she should not have been sent to collections regarding her premium payments. As indicated in our letter dated October 10, 2014, the checks [redacted] sent were not able to be identified initially. Thus, while research was taking place, her account lapsed and was sent to collections. This has been cleared up and our records reflect that any reference to collections has been cancelled. Though we cannot speak for the collections office, it may take additional time for their records to catch up and reflect this same information.If we may be of further assistance, please feel free to contact Dental Customer Service at: ###-###-####.Sincerely,Lisa RSpecialized Services Representative

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

Review: I signed up for dental coverage in February 2014 for coverage. I was sent an email stating my monthly fee would be deducted from my checking account on the last day of each month. I never noticed it was being deducted approximately 5-6 days earlier than that. It never affected my account so I did not pay mind to it. In May, the deduction overdrafted my account, bouncing a check. I found out the email I received was an error and that the 25th of the month was the due date. A supervisor at the call center advised that if I sent a copy of my bank statement showing it was their fault that I received a bounced check fee they would refund the fee. I sent it the very next morning to the fax number provided to me. I did not hear anything back for 2 weeks. I refaxed the info and still did not hear anything. I called them back and spoke with a supervisor that said she was working on my claim personally and that I would be refunded within a couple days. I inquired if this was going to affect my standing membership and she said no. I still have not received a refund and my coverage was in fact canceled.Desired Settlement: For all the inconvenience I have gone through and gotten nowhere with this company, which I thoroughly researched before joining, I would like a full refund on premiu** paid, plus the overdraft fee that was caused by the early debit from my account. I was not able to use any coverage and will now have to start over with another 6 month waiting period before I can get any dental work done. I do not appreciate being blatantly lied to and given poor customer service, as I am the head of clai** of customer service for a company, myself.

Business

Response:

July 15, 2014Dear **. [redacted]:I am writing in response to your letter dated July 10, 2014, concerning dental coverage for [redacted]. We received this letter on July 10, 2014.**. [redacted] is covered as a subscriber under the Individual Dental Program. The effective date of coverage was March 1, 2014, under group number MPA151103. The situs of this fully insured plan is in Pennsylvania.**. [redacted] expressed concern that her account was drafted to cover her premium and as a result, she received charges from her bank for an overdraft. In addition, **. [redacted] wishes to cancel her Individual Dental Plan and receive a full refund.Our records show that the automatic draft of **. [redacted]’s account was to occur on the 25th of each month. This is the typical arrangement made when members opt to have funds automatically withdrawn from their account. **. [redacted] reported this created an overdraft on her account and her bank charged her $35.00. We received **. [redacted]’s fax showing the overdraft charge on June 13, 2014. A refund check was mailed in this same amount to **. [redacted] on June 26, 2014.Based on **. [redacted]’s request, we have requested that her contract be cancelled as “never in force”. Currently our records show that a reversed payment was issued back to her account in the amount of $31.45 on May 30,2014. A refund in the amount of $94.35 will be processed and sent to **. [redacted] in the near future.If I may be of further assistance, please feel free to contact me directly.Sincerely,

Consumer

Response:

[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.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Although, I did not receive the check sent out on May 30th as they report. Are we able to look further into this? They can research into their accounting records that it was never cashed. Is it able to be resent or credited directly to my bank account?

Regards,

Review: I recently had a Porcelain Onlay procedure done to a tooth that was cracking and that was necessary since the filling wasn't working anymore. I had my dentist check with my insurance company, TWICE, to make sure that it would be covered under my United Concordia Insurance. They informed the dentist, twice, that it was covered. So the procedure was completed. Now, I get the bill where the insurance company UNITED CONCORDIA, that I pay the "HIGH DENTAL" for, has only payed $55.20 of a $749 procedure. I called customer service and they informed me that the code was changed by United Concordia because they didn't think the procedure was necessary and could have been done cheaper. So, they didn't call the dentist to confirm, like most insurance companies do, but went ahead and denied the claim. Sounds like the Erin Brockovich story and some other movies where the insurance company automatically denies the claim. Which by the way,

is exactly what the customer service rep told me, is that my policy is supposed to automatically go to the lower amount or be denied! So how is this "HIGH DENTAL"? United Concordia is no better than [redacted]. I used to talk about stories like this, now I'm part of one. Do not use this company if you plan to have any actual

dental work done.Desired Settlement: They need to pay everything with maybe a small deductible of $50 or even $100. If an auto company can do the "high coverage" correctly, why can't a larger insurance company do it right?

Business

Response:

Good Afternoon [redacted]

United Concordia received complaint ID [redacted] from your department on 7/28/2014. Based on the information provided we are unable to identify the subscriber and address their concerns. We tried calling the member at the phone number referenced on the complaint but was unable to contact the subscriber. We would need a valid United Concordia identification number to address the concerns in this complaint.

Thank you,

Amy *. R[redacted]

Review: Had dentures made, paid 1416.00 directly to dentist before they were made. Copay was 1200.00 which I was responsible for. Called dentist who gave me the runaround. Then called United Concordia who told me they couldn't talk to me directly I would have to call [redacted] even though United Cocordia was the provider. Called [redacted] five or six times. [redacted] told me I was right I overpaid 216.00 dollars but they would have to talk to United Concordia. They never got back to me. This was six differnt phone calls and over a 10 month period.Desired Settlement: I overpaid 216.00 dollars, the dentist was a network dentist who must accept the network payout. This was explained to me by [redacted]. Please note: United Concordia would not let me talk directly to them. I had to call [redacted] who would then call United Concordia. This was ridculous and time consuming as my information would have to be given to a [redacted] rep then passed on. As stated above [redacted] never got back to me and every time I called I would have to strart over with all the info.

Review: My husband and I both purchased United Concordia individual dental insurance thru the on-line PA based market place in March of 2014. In Sept of 2014 we both were informed that our insurance will be cancelled as of Jan 2015 because the company will "no longer be covering individual plans". The issue we have with this is that we had a one year "waiting period" before this insurance company would pay for any type of dental work. This includes just a regular exam and cleaning. So we have been paying monthly for this insurance and will never get to use it. We want our money back.Desired Settlement: We would like our money back.We each have paid - Year to date $311.67.We have 2 separate policies: [redacted] - Member ID#[redacted] - Plan/Group# [redacted] - Member ID#[redacted] - Plan/Group #[redacted]Please advise also if we need to file 2 separate claims

Business

Response:

September 29, 2014Dear [redacted]:I am responding to your letter regarding coverage for [redacted] and [redacted]. Your letter was received on September 22, 2014.**. and [redacted] are covered on a dental PPO planthrough [redacted]. The effective date of coverage was May 1, 2014, undergroup number [redacted].The iDental plans through United Concordia will no longer be available as of January 1, 2015. The members were sent a letter advising them of another plan in place that they can enroll in where the waiting periods would be waived. For more information on this plan the member can contact the sales department at [redacted].I hope this information will be helpful. Please feel free to contact me if you have any questions.Sincerely,Nyla JSpecialized Services Representative

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: We are aware of everything stated in this letter. In fact, all it says that we began with United Concordia in May 2014 and will no longer be enrolled as of Jan 2015.THE ISSUE WE HAVE IS THAT THERE IS A 12 MONTH WAITING PERIOD BEFORE WE ARE ABLE TO USE THIS INSURANCE. SO WE HAVE PAID FOR THIS INSURANCE SINCE MAY 2014 BUT WE WILL NEVER GET TO USE THIS INSURANCE BECUASE WE WILL NO LONGER BE ENROLLED AS OF JAN 2015.We would like a refund of our money because we never even got past our waiting period.As stated in previous email (see below) - we would like a refund;

We would like our money back.

We each have paid - Year to date $311.67.

We have 2 separate policies:

[redacted] - Member ID#[redacted] - Plan/Group# [redacted]

[redacted] - Member ID#[redacted] - Plan/Group #[redacted]

Regards,

Business

Response:

October 8, 2014Dear [redacted]:I am responding to the member's rejection to our response. Your letter was received on October 2, 2014.No refund will be issued for this policy. The member was provided services from the effective date of coverage, May 1, 2014, to present. If the member would like to continue services as of January 1, 2015, they can contact the sales department at ###-###-####, to inquire about coverage where the waiting periods will be waived.I hope this information will be helpful. Please feel free to contact me if you have any questions.Sincerely,Nyla JSpecialized Services Representative

Review: I paid for an insurance plan on Feb. 25th 2014. I have not received my acct information and have gotten no response after I attempted contact 3 times.

I purchased online Feb. 25th a dental plan for $102 a month that was supposed to have my benefits begin March 1st 2014. I have not received any account information so I can begin scheduling my daughters dentist appointments. I cannot even create an online account without this information. I sent them an email on Feb. 26th, noting that my payment had cleared from account and I wanted to know how to access my account information. I received no response. I then called at noon PST on Feb. 5th and was on hold for an hour before I had to go back into work and had to hang up. I then emailed on March 2nd explaining not receiving my account information, not receiving a response to my email and not being able to reach anyone and therefore, I wanted to cancel my order and want a refund. I have received no response to that either.Desired Settlement: I want my $102 back and my account canceled.

Business

Response:

March 21, 2014I am writing in response to a complaint that was posted on March 11, 2014, by [redacted] regarding her not receiving account information in order to schedule her daughter’s dental appointments, as well as being unable to create an online account. We received your email on March 14, 2014.Our research reveals that we received **. [redacted]’s application for the I-Dental individual 201 plan on February 22, 2014. **. [redacted] was sent an email on February 22, 2014, to inform her that the application had been approved. On February 25, 2014, we sent an email to **. [redacted] informing her that her bill was ready to be viewed.There is no record of **. [redacted] calling either United Concordia’s Customer Service department or the Billing and Enrollment department. The email address that’s posted on **. [redacted]’s file is [redacted] and there are no emails in our mailbox or the archives from this address. Our clerical department also posts emails and images they receive from a member’s case. No logs of this kind are posted on **. [redacted]’s file.Due to the unfortunate circumstances **. [redacted] experienced, we have terminated her case, [redacted] and requested an expedited refund of $102.76. This was requested on March 17, 2014, and expedited refunds usually take three to five business days to process.If I may be of further assistance, please contact me.Sincerely

Consumer

Response:

---------- Forwarded message ----------

From: [redacted] <[redacted]>

Date: Wed, Apr 9, 2014 at 11:35 AM

Subject: complaint #[redacted]

To: [email protected]

I just sent a message to them through their contact us form, since they have yet to provide me with a direct email address and I am working the same hours they are so calling and waiting on hold is not really feasible.

I explained in my message to them that I did finally receive the refund check. They sent it to wrong address, my physical instead of my mailing, I live on a nature preserve where there is no way a mailman could even get his little car up my road.

The post office was kind enough to call and let me know they had the check and I could pick it up or they could return to sender.

I called United Concordia and spoke with a gentleman, explaining that I was worried the check wasn't good anymore and whether I should wait for them to issue a new one. He told me the check was fine and to go ahead and deposit it. That I would only need to call them back if there was an issue when I deposited it.

I deposited it the next day, which was last week. Yesterday, the 8th, my bank notified me that a stop payment had been put on the check, the money was taken out and I was charged a $10 fee for the returned check and a $3 fee for having to pull money out of my savings to cover it.

I explained to United Concordia my bank is now sending me back the bad check and that a new check will need to be issued that now includes the $13 in fees I accrued at their fault, making it a total of $115.76.

I have asked them to send it to my work address, which I provided and I am awaiting response.

Thank you,

Business

Response:

Dear [redacted]:

I apologize that you have been experiencing these many difficulties when trying to get your reimbursement. However, please be aware that we are making every effort possible to assist you with your efforts.

Yes, you may scan and email the documents to: [redacted]

[redacted] has informed me that when he receives the information, he will take care of it right away.

Thanks

Review: To whomever this may concern, my wife and I have been in need of severe dental work(as in surgery and several root canals, extractions, and partials made )since I have left the military service. I enrolled in I-Dental plans best plan that would cover all of our needs. Unfortunately we would have to wait a one year period of being on the plan in order for the plan to work in our behalf. We enrolled in April of 2013. In September United Concordia sent us a letter stating that they were going to terminate our policy for non-payment. We checked our records and even though we could not find the error and it was a week before we got paid again we had to result in going to a cash advance in order to cover the cost of two months coverage to bring the policy current. When I called again the next month the representative from United Concordia told me that we did not owe anything until December 2013. And I had asked him why, he responded that I had over payed so that took care of the months of October and November. I then told him that I wanted to set up automatic withdrawal in which I proceeded to give him my bank account information. In January of 2014, I first received an e-mail stating that my I-Dental statement was ready for viewing and that I was to click on their login site. When I did it would not let me login. So I waited a few days before calling in I thought it was because of the New Year the site might be updating or too many users. But then I receive in the mail a letter from United Concordia stating that our policy was terminated and that they were no longer accepting anymore payments from us. I called in on January 14, 2014 and I was told that we owed since October, and that our last payment was in September2013, my last phone call was on October 8th,2013 and that in order to get automatic withdrawal I would have to do it myself online. This representative also told me that there was no reinstatement policy and that we would have to wait “THREE YEAR” to reapply and it as up to United Concordia to except us or not. This means my wife and I have paid out for seven months of services that we never got to use due to their policy, we tried to set up payment automatically, they do not except paper checks so there for we cannot use our banks web bill pay that will do the automatic pay for us. I believe that it is cruel, unethical, and unconstitutional to do anyone this way. It is bad enough that we have memory issues and we constantly have reminders all over the house, and United Concordia will not cut us some slack. It is not like we don’t want to pay for the insurance; even car and home insurances don’t do this to you. I thought this was America, I thought this is what I put my life on the line for in more than one occasion. Thanks for your support Untied Concordia! I guess you look out for yourself, I guess that is how you make your millions of dollars. We have a saying in the military that rings true from one branch of service to the next and that is “Let no man or woman be left behind”. Your company sure could use a real make over starting with your policiesDesired Settlement: Reinstatement of our policy or a refund of the seven months that we paid into the policy that was not used!

Business

Response:

Attached is the response for case ID [redacted].

January 22, 2014

Dear **. [redacted]:

I am writing in response to your letter dated January 14, 2014, concerning the above complainant: We received your letter on January 14, 2014.

**. and [redacted]. [redacted] indicated they had enrolled in the Individual Dental Plan through United Concordia effective May 1, 2013. **. [redacted] indicated that he had issues with trying to get his premium payments submitted.

The records show that the premiums were paid by **. and [redacted]. [redacted] through the end of October, 2013. As of November 1, 2013, the coverage is showing terminated. A review of the call records show that on October 8, 2013, **. [redacted] called to verify what date he was paid to and when his premium would be due. He was advised that he was paid till the end of October, 2013, and that his November 2013, premium would be due by the end of October 2013.

On October 30, 2013, an e-mail was sent to the Santiago’s advising them that their premium was due for November 2013. Again, November 14 and November 20, 2013, e-mails were sent advising that the premium was overdue. Finally, on December 10, 2013, a letter was sent via regular mail advising that their policy was terminated effective November 1, 2013, for non-payment.

On January 1, 2014, **. [redacted] called and was advised that since his policy was terminated for non-payment and no communications were received from him that his option would be to reapply after a three year waiting period for new coverage. The guidelines for enrollment and payment are clearly stated when members enroll for this type of coverage through l-Dental on the website.

If we may be of further assistance, please feel free to call Dental Customer Service at: ###-###-####.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because: It is in part a lie to cover themselves as a company. I received no such email and their time frame for the calls that I made are wrong and some are missing. I have also spoke with others, coincidentally they had similar stories to tell about United Concordia's I-Dental plan and the way they operate. So, NO! I do not except their response in anyway, shape or form. They are wrong for what they have done and continue doing. As I said before, it is not like I wanted free service from them, I wanted to pay and continue with them but it looks as if this is the way they make there money. We never got to use any of the services we paid in on, because we have to wait a year before we can be covered to get the coverage necessary that is needed, so tell me, who is making out big time? it sure is not us!

Regards,

**. & [redacted]. [redacted]

Review: I had joined united concordia's dental plan for many years, and I always use the same credit card to do auto payment every month, it never had any issue, until last Sept. 2012, a representitive from united concordia called me state their billing system have issue and can not withdrawl my fund, asking me to do a one-time manual payment, so I went ahead and made the payment with the same credit card, obviously my credit card don't have any issue, it is not expired nor pass the credit limit. I thought it is a one time issue on their system, and don't put much care about it.

But on Jan. of 2013, I got a letter which states my account was cancelled because of non-payment, I immediately contacted united concordia, asking whether they have received my Sept. payment, they replied stating 'Yes', but said they have to cancell my account on October because of non-payment, even if I told them it was their system failed to make auto payment with my credit card, not my credit card has any issue, and I've used the same credit card made the payment after you guys contacted me on Sept. but strange thing is that they insist they have to cancell my plan even if my credit card don't have issue.

I've contacted their customer service many times, but their representitive said it is their supervisor made the decision and they can not change it.

I had tried to coordinated through [redacted] to resolve the issue, since I appled the dental plan through [redacted], but last reply I got from ehealth representitive make me more upset with united concordia, united concordia informed [redacted] that their system never had any issue.

I'm not clear whether it was really a system error or it is an alibi used to cancell my plan.Desired Settlement: I think united concordia need to restore my policy since my credit card don't have any issue, I don't change the card No. it does not pass credit limit, and it is not expired either.

Business

Response:

See atached reply to complaint. Thank you.

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:

what they said they can not process my credit card on Sept. 2012 because my card is expired is absolutely false. my card did not expire at the time, and I'm willing to release my card No. to Revdex.com, so Revdex.com can check with my credit card company and see whether my card has expired or not; actually united concordia has my card No., they should contact the credit card company to check the status of the card before sending wrong information to Revdex.com, saying my card is expired. And there is no need to resetting my account as they refered to on this letter, because my card did not change, the No, not expired, not pass the credit limit, it is their representitive called me on Sept. 2012, saying their system had issue, and ask me to make one time manual payment, that's it.

I just called my credit card company and asking for a letter to show my card status last year and now if there is any issue, and I'm willing to attach the letter later on to help clarifying the case.

Regards,

Business

Response:

Please see attached response. Thanks.

Review: Dear Madam/Sir:

I am sorry to bother you for this issue. [ am having a claim argument with my former dental issurance provider as follows:

United Concordia (www.UCCI.com) PO Box 69420 Harrisburg, PA 17106-9420 Claim#: [redacted] My ID#:[redacted] Group Number: [redacted]

I bought the above insurance through my former employer (Salient Federal Solutions), which was effective on Feb. 1st, 2013.

I had a crown procedure by my dentist starting on 01/15/2013 and ending on 02/16/2013. I was working in Downtown DC during this period. My reimbursement claim for this procedure was denied by United Concordia with the reason of "pre-existing condition" later on.

However, as a matter of facts, this procedure was finished on 02-16-2013 as officially recorded. The so-called "pre-existing condition", which is described and excluded in UCCI policy, is referring to "diseased condition", not the ‘procedural sequence or timing" as well-known defined in every (often routine) policy by all other dental insurance companies. Therefore, I have been requesting UCCI again to reimburse this claim ASAP but they still reject with the same reason.

Therefore, I further requested them to point out where is this "pre-existing condition" policy located in their document, becaue I have the Dental agreement at hand which was provided by the employer ([redacted]) at the time that their service purchased, no anywhere that either I or their staff at 800 phone could figure out the page and the section that this policy is located.

However, their written response was only an isolated paragraph of quote without any context, section or paging, which you cannot tell where it came from, it was as follows:

"payment will not be made for crowns, iniays, onlays, post and cores, dentures or fixed partial dentures......"

I am pretty sure that the above quote was not in the Dental agreement at my hand.

I am so sorry to bother you, please help me to get UCCI to pay my claim that they are supposed to pay, please help

Thank you very much!

Sincerely, YoursDesired Settlement: Please see attached letter.

Business

Response:

October 10, 2013

Dear **. [redacted]:

I am writing in response to your letter dated October 9, 2013, concerning a claim for a crown for [redacted] completed on February 16, 2013. We received this letter on October 9, 2013.

**. [redacted]’s plan is self-insured and United Concordia provides administrative services only. However, as a courtesy, I will explain the circumstances surrounding this claim.

On February 21, 2013, we received claim number [redacted] from **. [redacted] for a post and core buildup and a crown on Tooth Number 20. Payment was made for the post and core buildup in the amount of $195.00 to **. [redacted]. No payment was made for the crown because the condition existed before the effective date of the patient’s coverage. A Dental Explanation of Benefits statement was issued May 2, 2013, advising **. [redacted] and **. [redacted] of this decision.

On June 17, 2013, we received an appeal request from **. [redacted]. During the appeal review it was noted that there was a clause in **. [redacted]’s dental agreement that indicates: crowns that are initiated or prescribed prior to the effective date of the member’s contract are not eligible for coverage.

**. [redacted]’s coverage became effective under [redacted] on February 1, 2013, and was cancelled on May 17, 2013. We contacted **. [redacted]’s office and confirmed that the impression was taken for the crown on Tooth Number 20, on January 15, 2013. This means, preparation for the crown began prior to the effective date of coverage, making the service ineligible under the member’s dental contract.

**. [redacted] would be able to find this specific exclusion under the pre-existing conditions section in his dental contract and in the exclusions and limitations section as well. We have also provided this information in a previous document to **. [redacted].

If I may be of further assistance, please feel free to contact me directly.

Sincerely,

Review: United Concordia Dental Insurer does not pay the majority of their claims received. Since 7/28/11, my family of four has had 70% of all dental claims wholly or partially denied by this insurer, usually because they declare the work "unnecessary." Work that was denied includes replacement of 40-45 year old fillings that were causing cracks in the teeth, a crown for a badly cracked tooth, and periodontal work for two family members. I have contacted customer service and the appeals process within their system has been exhausted, and they state that the only recourse is civil litigation (!). Dates of service and status of claims are as follows

Family Member A:

Rejected (either wholly or partially): 9/17/13; 9/25/13

Approved: 9/11/12; 3/12/13

Family Member B:

Rejected(wholly or partially): 2/4/12; 11/29/12; 12/4/12;12/6/12; 4/29/13;6/11/13

Approved: 12/12/12

Family Member C:

Rejected (wholly or partially): 1/22/13; 7/23/13

Approved: 7/9/12; 1/22/13

Family Member D"

Rejected (wholly or partially): 10/2/13; 2/18/14; (second claim) 2/18/14

Approved: 10/1/13Desired Settlement: 1. An independent review of United Concordia's claims processing policy by the insurance commissioner

2. Payment of above-listed claims

Business

Response:

April 18, 2014Dear **. [redacted]:I am writing in response to your letter dated April 16, 2014, concerning claims for the [redacted] family. We received this letter on April 16, 2014.The [redacted]’s have a PPO group dental plan through [redacted] Medical [redacted]. This is a self insured plan and United Concordia provides administrative services only.In the letter, **. [redacted] provided a listing of service dates for each member of the family that she believes were not processed correctly by United Concordia. The following represents our findings:[redacted]:Date of Service:September 17, 2013 Claim Number: [redacted] Total Charges: $314.00 Amount Paid: $153.00**. [redacted] is responsible for non-covered services which are listed on the Dental Explanation of Benefits statement dated October 3, 2013, which is enclosed.Date of Service:September 25, 2013 Claim Number: [redacted] Total Charges: $526.00 Amount Paid: 220.15**. [redacted] is responsible for the provider’s charges less any amount paid for the restorations and deductible. These amounts are listed on the Dental Explanation of Benefits statement dated October 10, 2103, which is enclosed.[redacted]Date of Service:November 29, 2012 Claim Number: [redacted] Total Charges: $224.00 Amount Paid: $192.00**. [redacted] is responsible for the non-covered fluoride only. A copy of the Dental Explanation of Benefits is enclosed.Date of Service:December 4, 2012 Claim Number: [redacted] Total Charges: $393.00 Amount Paid: $71.00Charges for the scaling and planing 4 + teeth were not considered because x-rays and periodontal charting were not sent by **. [redacted]. It is **. [redacted]’s responsibility to provide this information so the claim can be reconsidered. A Dental Explanation of Benefits statement dated December 6, 2012, is enclosed.Date of Service:April 29, 2013Claim Number: [redacted] Total Charges: $143.00 Amount Paid: $41.25**. [redacted] is responsible for deductible, coinsurance and the service not paid because of frequency. A Dental Explanation of Benefits statement dated May 9, 2013, is enclosed.Date of Service:December 4 and 6, 2012 Claim Number: [redacted] Total Charges: $1492.00 Amount Paid: $ 0No payment was made for these services because the x-rays and periodontal charting were not sent by **. [redacted]. A Dental Explanation of Benefits statement dated June 20, 2013 is enclosed.Date of Service:June 11, 2013Claim Number: [redacted] Total Charges: $1089.00 Amount Paid: $ 0No payment was made because the x-rays were not sufficient to determine eligibility for the services. A Dental Explanation of Benefits statement dated October 10, 2013, is enclosed.[redacted]Date of Service:January 22, 2013 Claim Number: [redacted] Total Charges: $118.00 Amount Paid: $42.40The member is responsible for coinsurance amounts. A Dental Explanation of Benefits statement dated March 21, 2013, is enclosed.Date of Service:July 23,2013Claim Number: [redacted] Total Charges: $205.00 Amount Paid: $122.40The member is responsible for coinsurance amounts. A Dental Explanation of Benefits statement dated August 15, 2013, is enclosed.[redacted]Date of Service:October 1,2013 Claim Number: [redacted] Total Charges: $441.00 Amount Paid: $132.00The member is responsible for the non-covered service and the unpaid service due to frequency. A Dental Explanation of Benefits statement dated October 3, 2013, is enclosed.Date of Service:February 18,2014 Claim Number: [redacted] Total Charges: $112.00 Amount Paid: $80.00Member is responsible for the fluoride. A Dental Explanation of Benefits statement dated February 20, 2014, is enclosed.Date of Service:February 18, 2014 Claim Number: [redacted] Total Charges: $483.00 Amount Paid: $ 0This claim was reviewed by two Dentist Advisor’s and both determined that payment is not eligible for the services reported. Dental Explanations of Benefits statements dated March 27, 2014, and April 10, 2014, are enclosed.If I may be of further assistance, please feel free to contact me directly.Sincerely,

Consumer

Response:

[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]

Review: [redacted]

I am rejecting this response because:1. A "Dental Advisor" decides if a procedure qualifies for coverage, rather than the attending dentist. There is no recourse beyond the appeals process besides "civil litigation." Therefore, any procedure may be rejected at United Concordia's whim, without realistic consumer recourse. 2. I was informed by a customer service representive on 4/14 (she called me) that United Concordia "sets the bar high" when deciding what will be covered. With regard to periodontal scaling, the company requires the dentist to provide an exceptional amount of documentation as evidenced by this statement: Procedure RejectedPeriodontal scaling and root planing requires review by a

Dentist Advisor. In order for the service(s) to be considered, please submit

full mouth duplicate radiograph or digital images and complete periodontal

charting. A complete and compliant 2006 or 2012 ADA claim form must be submitted

with the requested documentation.Procedure RejectedWith regard to radiographs:Procedure RejectedPeriapical radiographs performed on the same date as a

periodic oral evaluation requires review by a Dentist Advisor. In order for the

service(s) to be considered, please submit a copy of the periapical

radiograph(s) or digital images and an explanation of the patient's specific

signs and symptoms. A complete and compliant 2006 or 2012 ADA claim form must be

submitted with the requested documentation.Procedure Rejected3. United Concordia failed to respond to multiple requests for pre-authorization of work in late 2013/early 2014 for family member D. They claim they never received the multiple requests (per phone discussion with "[redacted]" on 4/7/14), despite documentation from the dentist showing otherwise. The service was ultimately performed and denied as unnecessary. As an aside, [redacted] also informed me that he speaks with customers who are experiencing similar difficulties with United Concordia "all day long."

Regards,

Business

Response:

April 24, 2014Dear **. [redacted]:I am writing in response to your letter dated April 21, 2014, concerning [redacted]’s questions about our response dated April 18, 2014. We received this letter on April 21, 2014.**. [redacted] questioned our “Dentist Advisor” making decisions on patient treatment. United Concordia would never propose that patients deny themselves necessary care. In all situations, a provider must use their professional judgment to provide care they believe to be in the best interest of the patient. As always, the dentist and member are responsible for treatment decisions. Our determinations are made for coverage purposes only and cannot supersede the professional judgment of the treating dentist.**. [redacted] states that United Concordia expects an exceptional amount of documentation with regard to periodontal scaling and root planing services. All claims are processed according to the terms of the subscriber’s contract and the information reported on the claim form. United Concordia Dental contracts include provisions requiring input from our Dentist Advisors to determine United Concordia’s financial responsibility. We are responsible for ensuring that payment is appropriate for the care our subscribers receive. Our dental review program fulfills this responsibility.United Concordia Dentist Advisors review cases by studying claims history, reports, correspondence and diagnostic information such as radiographs. Following the review, the claim is processed based on the Advisor’s opinion and the subscriber’s contract.In addition, **. [redacted] questions our policy with regard to periapical radiographs. Periapical radiographs performed on the same date as a periodic oral evaluation requires review by a Dentist Advisor. This policy was put in place in part to prevent routine taking of radiographs, unless a specific reason is documented and in keeping with the American Dental Associations recommendation on taking of periapical radiographs without a specific diagnostic reason.**. [redacted] believes that United Concordia did not respond to multiple requests for a dental predetermination submitted by Dr. [redacted]. As was indicated during conversations with **. [redacted], we have never received a predetermination request for any services to be provided by Dr. [redacted]. We did receive a claim for services dated February 18, 2014, for [redacted]. However, prior to those services actually being done on that date, we did not receive any request for a predetermination for services to be provided by Dr. [redacted].If I may be of further assistance, please feel free to contact me directly.Sincerely,

Review: aMy husband, who is now retired military, had dental insurance though united concordia when I had my wisdom teeth removed in March 2012 because of chronic headaches. United Concordia was to be responsible for a percentage of the bill to which they never paid. I paid my portion. During the time my oral surgeons office was attempting to collect the insurances portion of the bill, the military changed service providers to [redacted]. Now there is no way to get in touch with United Concordia. Myself and the dentist office have been forced to correspond through e-mail, which has yield no results. It has been a frustrating situation that I would like resolved as its been over a year. To pay the remainder of the bill out of pocket would be a financial burden and frankly should not be passed on to my family as we had insurance through this company at the time of my procedure. I have proof of the numerous emails that were sent by myself and the dental office trying to resolve this matter. It has been equally frustrating to not have any way to speak to a representative of United Concordia to determine how to fix this mess! The current remainder of the bill is $871.88. It has also been accruing late charges as a result of United Concordia's disregard to honor their obligation to their customer.

Any help in this matter would be greatly appreciated

Thank You

[redacted]Desired Settlement: I would be very pleased if United Concordia would simple honor their obligation and pay the current portion of the bill that they have failed to do for over a year.

This bill which has hung over our head has caused a great deal of stress and anxiety.

Business

Response:

Due to the Federal Privacy Act, we will respond directly to the member.

Review: I called United Concordia (phone number ###-###-####) on 07/01/2013 about cancellation of my dental insurance policy. After prolonged hold my call was answered by **. [redacted]. When I was unsatisfied with his answers on my questions and asked to speak to supervisor, **. [redacted] said "of cause" and transferred me somewhere. No one pick the phone after that and in 2 minutes my call was disconnected. When I called again it was another prolonged hold, after that explanation of my matter to another person, after that another hold and finally I was connected to supervisor named [redacted]. She told me that everything was done by the book and I should talk to my employer instead of talking to United Concordia. She refused to comment on my rude treatment by United Concordia customer service. It is not the right way to treat customers.

Business

Response:

reply attached. please review.

Review: I submitted a claims form 4/2013 for dental (braces) reimbursement to United Concordia. There is a $1500.00 lifetime allowable. I called May 20, 2013 to inquire on the status of my claim. I was told by a lady the claim was not processed because it was missing a date of service in a field. I expressed concern because I submitted the form myself. I called United Concordia to get clarification in regards to filling out the form. I filled all the requested fields only to find out a date of service was not in the correct field or missing. The lady took my request via phone and added the date of service in the correct field and filed the claim. I called back June 3, 2013 an spoke with a gentleman who told me the same thing. The claim was not filed and he would file the claim via telephone. I called back June 10, 2013 an spoke with [redacted] who told me the same thing. The claim was not filed and she would file it via telephone. I called back June 17, 2013 an spoke with [redacted] who told me the same thing. I asked to speak to her supervisor. [redacted] the supervisor expressed that she had submitted the claim properly this time. I called back June 28, 2013 an spoke with [redacted] who told me the claim was being processed. I asked to speak to her manager. I spoke with [redacted] who told me [redacted] was handling the claim an this process takes time. I asked [redacted] to call me back the following Monday to ensure the claim had been processed and to give me an update on the status. I have yet to hear from [redacted]. I've expressed to several of the above mentioned people that this is very poor customer service. I expressed that United Concordia has no problems with taking my premium biweekly so I should have a issue with being reimbursed. This has gone on far to long. I called the automated system July 7, 2013 only to find out the claim as yet to be paid. Please help!!!!Desired Settlement: Reimbursement of $1525.

Business

Response:

Attached is response to complaint [redacted] for [redacted]. Thank you.

Consumer

Response:

[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.]

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,