ComplaintsforDelta Dental of California Enterprises

Insurance Companies

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Customer Complaint:

BBB’s profile for Delta Dental of California Enterprises was created February 1991. A review of complaints was completed in March 2024. For questions related to your dental plan, consumers are encouraged to visit the following link.

https://pgesupport.zendesk.com/hc/en-us

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Initial Complaint
09/30/2024
Complaint Type:
Product Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I had a policy for Delta Dental when I lived in California. I left California in May 2024 but on July 18, 2024, Delta Dental sent a check for $498.20 to my old California address that is meant to reimburse my dentist for services rendered prior to me leaving California. After learning about this I contacted Delta Dental, provided a current address and was told it will take about fifteen business days for me to receive the check. Its been almost a month later and the check has not been mailed. I called today for an update and was told since I did not call back within two weeks they could have helped. Now, Im at risk of this account going to collections because Delta Dental is now telling me it will be another 15 days before I can get the check. I spoke to ******, and the supervisor was ******* ******, who refused to get on the phone.
Initial Complaint
09/30/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
On 5/20/24 went to dentist found out I need gum surgery; on 6/11/2024 Dental Dental denied service said I need x rays; on 7/22/24 had the x ray completed; on 8/13/2024 dentist resubmitted request for approval of surgery; 8/19/2024 delta dental scanned info into computer but dropped the ball and did not submit information for approval; Because I did not receive approval I contacted Delta Dental and was told we have all the information and we have up to 6 weeks before we have to inform you of our decision. I waited until the 6 week period and called back again on 9/25/2024 again there are no answers I asked to have a supervisor call me back INQ ****** they have 24 - 48 hours to call me back. No call back, I called again today 9/30/2024 again asked for a supervisor ******* G #SF2024093054949682 spoke with me and said someone from Delta Dental dropped the ball. I had to change my surgery date from 10/1 2024 to 10/22/2024. I asked ******* if she could expedite the decision as I have been since May. ******* said she could not expedite, I asked to speak with her supervisor she said she has no supervisor all I could do was to go to their website and put in a formal complaint. I do not believe no one could do anything in this place of business. They have continued to lie to me over and over again to just get me off the phone.
Business response
10/04/2024
Good morning

This was approved on 9/30/24 please allow 7-10 business days to receive your statement

Thank you
Customer response
10/04/2024
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. Thank you for your help.

Sincerely,

**** *********
Initial Complaint
09/24/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
My daughters ******* and **** ***** received cleanings on 7/18/2024 from Beautiful Smiles dental clinic in ****, **. We paid upfront and are still waiting to get reimbursed from Delta dental. Beautiful Smiles have submitted claims to Delta Dental x3. Delta Dental has stated they are waiting for claims to be sent. Its a lie. I just want paid
Business response
09/25/2024
Good morning

Please respond with your enrollee id

Thank you
Customer response
09/28/2024
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

Sincerely,

**** *****
Initial Complaint
09/17/2024
Complaint Type:
Order Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Delta Dental is refusing to pay claims that should be paid.
Business response
09/18/2024
Hello,

Please provide a claim number or date of service.

Thank you
Initial Complaint
09/14/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
My kids **** ** and ***** ** had a dental cleaning on 08/14/2024 and 08/13/2024 respectively.Before the dental visit, we called the delta dental************* at 1:18PM 08/13/2024) support to confirm that the clean will be covered by our dental insurance plan. The support confirmed that two cleans would be covered by the plan every calendar year. Since our previous clean happened in Feb 2024, these cleans should be covered by the plan.However, we received the bills which charged us $113(Claim number ****************) and $70(Claim number ****************) respectively. We contacted delta dental ************* at 2:55PM 09/03/2024) and the support said the plan covered at most 2 cleans in continuous 12 months. Since we had cleans at 8/22/2023 which was less than 12 months before, the last clean won't be covered by the plan. The first delta dental support gave misleading information which caused us $183 loss. If the support could give the correct information, we would schedule the visits two weeks later and all costs will be covered.
Business response
09/16/2024
Good morning,

Thank you we have received your complaints and grievances have been filed, please allow up to 30 business days for these to be resolved.

Thank you
Initial Complaint
09/11/2024
Complaint Type:
Customer Service Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
We have been trying to get an answer from Delta Denal since June 2024 regarding coverage for my beneficiary. So far, there have been four calls and conflicting information from all of the Delta Dental representatives. Today we asked to speak with a supervisor and were told it is not possible and there is no supervisor available. There is no phone number listed for the *** My son is dealing with an urgent matter and we need to speak to a manager who can explain the policy and his eligibility without being rude or condescending. Ive been a member of this plan for over 17 years and I certainly hope a conversation about our eligibility can be addressed asap. We do not wish to speak to a level two representative again.
Business response
09/13/2024
Good morning,
Please verify an id number so we can further assist you.

Thank you
Customer response
09/13/2024

Complaint: 22272698

I am responding to this response for additional information: please see attached.

Sincerely,

*******************
Business response
09/16/2024
Good morning,

Unfortunately there is no attachment. Please respond with the dob.

Thank you
Customer response
09/16/2024

Complaint: 22272698

I am rejecting this response because: I was asked for my enrollee ID, which I provided by attachment and in the text of the response. Youre now asking for my DOB. Please see below.
Name: *******************
Enrollee ID: ************
DOB: 12/18/1963
Address: *******************
Snellville Ga 30078
Phone: ************

Sincerely,

*******************
Initial Complaint
09/11/2024
Complaint Type:
Customer Service Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I cancelled my policy with delta dental in June because i obtained insurance through my employer. I am still being billed
Business response
09/13/2024
Good morning,

We show a cancellation date of 9/30/24. There is no record on file of a call or request in June to cancel the plan.

Thank you
Initial Complaint
09/06/2024
Complaint Type:
Product Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I have tried four claims, four letters and hours upon hours of phone calls. I am due reimbursement from a dental visit almost one year ago. Clearly completing their forms four times, submitting stacks of paperwork - they sent the check to the dental provider, instead of me (I never received any mail or confirmation or reaching out for additional information).What has led me to reach out today, beside the unresolved financial component is the abhorrent "customer service" and lack of oversight from Delta Dental. I have spent HOURS this afternoon alone trying to resolve the claim - as I was told I needed to give the department 30 days to review, which I have. Call #1: Told I needed to speak to the one *** working on my case On Hold for 1.5 hours and counting (no one checked in) Call #2: on the other line, she was going to check into it and would not leave the line....place me on hold Call #3: *** hung up on me because she didn't want to take my call Call #4: someone picked-up without speaking directly put me on hold I want to be done with the claim - and actually responded to.
Business response
09/09/2024
Hello,

You currently have two pending grievances on file that are being reviewed. We understand your concern/frustration however sometimes it takes our case workers a little longer to investigate if they are waiting on further information. As I have reviewed the claim you are requesting a reimbursement for I see the check was issued to the provider and that is because they are participating with Delta Dental. If they were an out of network provider a check would then be sent to you. If you have paid this provider more than $140 out of pocket and are requesting a refund that is considered balance billing in which case the provider is responsible for refunding you. If that is the case and you have a copy of your receipt I will be happy to get that attached to your case for you.

Thank you
Customer response
09/09/2024

Complaint: 22252125

I am rejecting this response because:
There are a few issues to discuss:
1. I called over six times on Friday alone, approaching 20 overall- *** yet to speak with someone with any progress (lots of hang-ups, no answers and hours of unanswered holds)
2. The latest grievance was supposed to be answered in 30 days- at 11:59pm on Friday 9/6. This has passed.
3. It is evident based on the unrelated letters- No one has read any of the letters, the details of the claim forms or any of the attachments submitted four times.
4. It is super simple- I paid $300 to the provider. Delta Dental sent a check to the provider. It has been almost one year needing that refunded me, which had been clearly stated in every letter, the attachment of my credit card receipt and the box on the claim form. I have submitted this four times from a consultation last November.

Sincerely,

*********************
Business response
09/13/2024
Good morning,

There were several grievances that have been answered in a timely manner. If you would like I can send you a copy of these letters. You went to a participating provider that is why the check was issued to their office and not you directly.

Thank you

Customer response
09/13/2024

Complaint: 22252125

I am rejecting this response because:
After nearly one year, I have followed each call, each instruction and filled out numerous forms. It is SO simple - how would Delta Dental like to reimburse me for the claim?
Why would you pay the provider since I already paid them $300 for the entire consultation (receipt of my credit card attached to each of the four times I filed a claim) and you are then paying them $140 on top?! They received the check and same-day returned it to Delta Dental because it.does.not.belong.to.them. The reimbursement, due to me, has not been sent to me. IF you sent it elsewhere then you can remedy that piece - between Delta Dental and myself, I have not received my dental payments due.
YOUR claim box 37 - Attached - authorizes payment payable to me directly to me to the named dentist - box 48: leave blank if dentist is NOT submitting claim on behalf of the patient. Both are blank = i did NOT authorize dental benefits payable to me to the dentist, nor is the billing dentist submitting the claim.
Again. 1. What grievance has been answered? NOTHING resolved for one super simple, small claim for a consultation.
2. Please explain what I need to do to receive the reimbursement for the claim?

Sincerely,

*********************
Initial Complaint
08/23/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I have switched over to COBRA coverage with my dental insurance at Delta Dental. According to my COBRA provider, they have activated my dental insurance and sent over the payments, but my dental insurance has still not been activated retroactively by Delta Dental since June 7, 2024. I have called both companies multiple times and they both blame each other for not getting my insurance activated, so I am filing a BBB complaint to hopefully get it resolved with both companies.
Business response
08/26/2024
Good afternoon,

Please respond with your date of birth or your previous enrollee id.

Thank you
Customer response
08/27/2024
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
It seems that Delta Dental has fixed my issue after I filed my complaint so I consider this issue resolved now.

Sincerely,

****************************
Initial Complaint
08/21/2024
Complaint Type:
Order Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
On July 14, 2022 my son was approved to get braces. Delta Dental stated at that time they would cover ******* of ******'s braces. On October 12, 2023, *************************** Orthodontcs filed a dispute with Delta Dental. Delta Dental then responded and told then they would not cover the ******* that is owed. They stated that a family plan only cover 5000, but I was not on a family plan. When I got my braces I was not on the family plan back in 2001. I was notified July 1st, 2024 that Delta Dental would not pay the ******* and we would have to pay. Delta Dental gave my orthodontist miss information and should pay the *******. I am filing a greivance with them via mail today. Thank you.
Business response
08/22/2024
Hello,

Please respond with your enrollee id.

Thank you

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