ComplaintsforDelta Dental of Colorado

• Initial Complaint

  10/06/2022

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I have encountered many issues with Delta Dental of Colorado (DDCO) and I suspect bad faith. As to date DDCO has failed to uphold their end of our contract. My office has tried to reach a successful outcome with Delta Dental Colorado *********** and Provider ************** to effectively process claims of DDCO subscribers/patients seen in our office since May 2022. Claim # ************ and Claim # ************, ************ has been outstanding since May 2022, with no payment made to me as a Provider to date. With continuous misinformation and miscommunication this cycle to retain payment as a Provider is endless. After trying numerous times to rectify via telephone, and with several rude customer ********************** representatives at DDCO I received a call from *****************************. Per Delta Dental of Provider Relations Advocate (*****************************) a check was said to be sent, but DDCO stated that they sent the check to the wrong Provider and Address, and to date has yet to send corrected payments to me directly. Numerous phone calls to DDCO lead to many excuses and several failed promises to rectify. As a company contracted with Delta Dental of Colorado, DDCO has done more harm than good for my office. DDCO has delayed communications in regard to submitted claims, and their customer ********************** is extremely unprofessional and inattentive. Delta Dental of Colorado *********** and Provider Relations has neglected to make proper payments to my office, with negligent delay tactics for processing Claim # ************ and Claim # ************, ***********, as well as many other claims currently processing from my office. Delta Dental of Colorado has poor implementation of established investigation and claims processing.

  Business response

  10/17/2022

  **********************,

  Patient SC had services completed 5/23/2022.  There were four claims received that denied, as we requested information from the patient.  Claim ************ was received 5/23/2022, information was requested and the claim denied 6/1/2022.  ************ received 5/23/2022, information requested and claim denied 6/7/2022.  ************ received 5/23/2022, information requested and claim denied 6/7/2022. ************ received 5/25/2022, information requested and claim denied 6/7/2022.  On 5/25/2022, DDCO received a claim, with all necessary information, and it was processed on 8/26/2022; $426.00 was issued to you and the check cleared 9/8/2022 check number ********* (copy attached).
  
  On 8/30/2022, we discovered incorrect fees were used for processing and we overpaid by $155.00.  An adjustment was issued and the overpayment amount of $155.00 was deducted from a future check, check #********* (copy attached).  Net payment for SC for services completed 5/23/2022 is $271.00, no additional payment is due.
  
  For patient RD, exam, x-rays, pulp test were completed 5/10/2022.  Claim ************ was received 5/24/2022,information was requested from RD and denied 6/7/2022.  In addition, ****************************************************************************** our system to enable claims processing.  These rejected claims were received 5/10/2020 through 8/30/2022; notices of the rejections were provided to RD.
  
  8/30/2022, claim ************ was received for RD and all information necessary to process the claim was received.  ************ was received 8/30/2022 and paid $57.00 for the pulp test via electronic deposit on 8/31/2022 (copy attached). D0220,D0140, D0270 were denied for frequency.  As a result of your letter, we found that the aforementioned services had incorrectly denied for frequency; an adjustment was initiated today to pay per the terms of the plan. An additional amount of $185.00 will be issued via electronic payment in the next few days (copy not yet available).  Net amount paid for RD is $242.00 for the exam, x-rays and pulp test.
  
  Also for RD, claim ************ includes a root canal, protective filling, photos, x-rays, exam, pulp test.  It was received 5/13/2022 and processed to pay $1,293.40 on 6/30/2022 (cannot attach due to too many documents). This payment processed incorrectly and issued to the wrong business; it was voided 8/31/2022. Claim ************ was received 8/30/2022 and included a root canal and protective filling.  We paid $86.40 on 8/30/2022 for the protective filling and the root canal was denied for frequency (copy attached). We determined this is incorrect and initiated an adjustment to pay for the root canal and per Delta Dental policy, the protective filling is not payable when completed in conjunction with a root canal.  An adjustment claim was initiated to pay $755.20 for the root canal; the previously paid amount of $86.40 for the protective filling is an overpayment and was recouped from the $755.20 payment issued 10/6/2022; this payment was $668.80 (copy attached).  No further payment is due for the root canal or protective filling.   
  
  We hope this brings satisfactory explanation and resolution to the concerns expressed to both the BBB and Dental Dental. 

  Sincerely,

  ****** T

• Initial Complaint

  08/22/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Delta Dental does not send Explanations of Benefits (EOBs) by mail and their website has been inaccessible for the past many months. In fact when I called, their employee said even he can't get into the website to review his own benefits. I need my EOBs to review before I pay my dental bills, I imagine they are required to provide this information. I asked the representative to mail me the EOBs about 2 weeks ago and still have not received.I would like Delta Dental to be chastised for not having a working website and to fix their website, or else mail all EOBs to their members.

  Business response

  08/26/2022

  Case #:                  17751937

  This notice is in response to the complaint sent to the Better Business Bureau.Delta Dental of Colorado (DDCO) received this complaint on August 23, 2022.  
  
  All of the available information related to the request has been thoroughly considered.  I ran a detailed search of DDCO's claims system in an attempt to locate the member. I can conduct another search if the member provides his date of birth and member identification number listed on the benefits card. Unfortunately, at this time Delta Dental of Colorado does not appear to provide coverage for this member. It is possible that Delta Dental in a different state provides this coverage. 
  
  Delta Dental of Colorado is a member of Delta Dental ****************** a network of 39 independent dental companies that conduct business in all 50 states, as well as ************************.  Each Delta Dental company has individual claims systems that include all enrollment and claims data for their own members and employer groups.  Member and claims data are not shared among the various Delta Dental companies as we are separate businesses.
  
  The complainant may want to review the benefits card issued by the carrier.  This will provide contact information for the appropriate carrier. If you have any further questions, please contact me at ********************.

   

  Best,

  V *****

• Initial Complaint

  08/05/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  3-23-2022 went to dentist for procedures, paid up front because dental office did not accept insurance, filed my claim with delta dental and it was lost supposedly. Refiled in June and claim was approved, they sent my check to the wrong person and has yet to give me my money back. Every time I call they tell me another 30 days.

  Business response

  08/12/2022

  Case  17676831

  This notice is in response to the complaint you submitted to the Better Business Bureau. Delta Dental of Colorado (DDCO) received this complaint on August 8, 2022.   We understand your complaint to be that DDCO has not provided benefits reimbursement to you for services on March 23, 2022; and that the reimbursement was incorrectly issued to your provider.  We have investigated the complaint completely. 
  
  All of the available information related to your request has been thoroughly considered.  Based on review of that information, we have found that a check was issued to ************************************, at Affordable Dentures &Implants Colorado Springs III PC, on June 30, 2022, via check *********.However, the submitted claim indicates he does not accept assignment of benefits; reimbursement was erroneously issued to ************. 
  
  As the reimbursement check has not been cashed, a stop-payment has been placed on check number *********, and a new check will be issued to you in the amount of $1,146.00.  You should receive the payment within the next two weeks.
  
  Thank you for bringing this matter to our attention. We hope this outcome provides satisfactory explanation and resolution to your concerns expressed to both DDCO and the Better Business Bureau.  Should you have further questions, you may contact me at ********************.
  
  Best,
  
  **************

  Customer response

  08/15/2022

   
  Complaint: 17676831
  
  I am rejecting this response because:
    This matter is not resolved until I receive check
  Sincerely,
  
  *****************************

• Initial Complaint

  01/18/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  We are trying to get through to Delta Dental Colorado to process a claim for one of our dental patients claim #************. After trying on numerous occasions to get through to a customer ********************** representative, the last being 1/13/22, I am not sure what to do. I was on hold for 2 hours with no response and sent a message in through their contact portal with no response. On 11/2/21 I was on hold for > 30 minutes and pressed 1 for a return call that never came. I sent a letter back to the company on 12/22/21 with no response. The parent is looking for answers as to whether or not their treatment will be covered, and I cannot get any answers through their "normal" channels. Additionally, I tried to connect to **** through the Toolbox, and while I have no problem getting access into the Toolbox site, when I follow the prompts through the **** website, the information crashes and I cannot view any **** options.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩