ComplaintsforDeltaCare USA

Dental Plans

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Initial Complaint
07/11/2024
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.
Trying to add our dental care provider to get a cavity taken care of for our 8 yr old daughter. The dentist as well as my husband have been trying to reach *********** they are in network. Neither the dentist nor my husband can get in contact with anyone. I will have to pay $600 out of pocket now, even though we pay to have dental insurance.
Business response
07/24/2024
Hello,

Please respond with your enrollee id.

Thank you
Initial Complaint
05/25/2024
Complaint Type:
Product Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
********** denied reimbursement of sedation for a child who had 4 wisdom teeth removed, 2 of which were impacted and required bony extraction. I am a pediatrician myself; there is no question that sedation was standard of care. And yet ********** denied the sedation charges and never told us that they denied them or why. We only learned of the denial from a surprise bill from the dentist 8 mo later. When we went to appeal with **********, they systematically created hurdles. When we cleared the hurdles, they said too much time had passed to appeal and they closed the appeal. ****** subcontracted Delta as part of the CA ACA. **********'s behavior represents gross negligence, and their systematic prevention of appeal could be construed as intentionally fraudulent behavior. We are looking for a reimbursement of the charges of $412 for sedation. More details below Our son had 4 wisdom teeth removed bilateral impacted molars and bony extractions requiring sedation on 8/22/23 ********** denied reimbursement of sedation We never received anything from Delta about the denial We learned of the denial in April when the dentist billed for sedation charges that were denied We immediately called ********** grievance line to appeal We were told by Delta that we can appeal and that an agent would reach out to take the appeal We never heard from Delta they never reached out or called We called Delta again and they said Oh we gave you the wrong info. The window to speak to an appeals agent has passed. You need to submit an appeal by writing We submitted the appeal in writing ********** never reviewed it Instead, they incorrectly sent us a letter saying the appeal is closed until we sign a HIPAA release This was not appropriate, as the patient is a minor and I am his parent They also provided an incorrect mailing address to return the release When we submitted those forms, Delta closed the appeal without reviewing it under the grounds that 180 days had passed
Business response
06/05/2024
Hello,

Your complaint has been received and routed to our grievance and appeals team for review.

Thank you
Customer response
06/06/2024

Complaint: 21760105

I am rejecting this response because: ********** did NOT respond at all. They acknowledged that a complaint was made, and that's it. They have a long track record of not responding to consumer complaints on BBB and have an F rating. And in this case, their behavior suggests systematically denying consumers a way to appeal and systematically creating hurdles, all of which can be considered consistent with fraudulent behavior.
***Warning to consumers, employers and any health plans who are considering subcontracting dental insurance to Delta Care (which ****** Permanente in ********** did in this case):
Delta is not behaving with integrity -- see BBB rating of 'F'
Delta inappropriately denies reimbursement for treatments that are standard of care (e.g., sedation for a pediatric case of bilateral impacted molars with bony extraction)
Delta systematically creates barriers preventing consumers from appealing their inappropriate denials.
Initial Complaint
05/13/2024
Complaint Type:
Service or Repair Issues
Status:
Unanswered
The business failed to respond to the dispute.
Automated phone system hangs up on callers after selecting to speak to a representative ************
Initial Complaint
03/07/2024
Complaint Type:
Service or Repair Issues
Status:
Unanswered
The business failed to respond to the dispute.
Following a medical issue, I was unable to work and left without dental insurance. I purchased ************** through AARP because it listed routine cleanings as being FREE. I went to an appointment today, which I believed would be a dental cleaning. Instead, I received a proposed bill for $5414, $1195 of which was the cleaning portion of the bill. This is a huge scam. I can pay my former dentist out of pocket and save myself thousands. Do not purchase DeltaCareUSA insurance.
Initial Complaint
12/14/2023
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.
***** care *** is my insurance. I went to my normal dentist and was told there was some thing that looked weird in my gums and they wanted me to see a specialist. I made an appointment with a specialist so now thats about two or three weeks later that they could see me. They told me there is an infection and that they need to do a root canal. I have waited two weeks now and not heard anything. I called the specialist. They said theyre still waiting for ***** care USA to authorize the root canal. Ill call ***** *** myself to ask why its taking so long and magically. They will now put it through they magically got it today. They now told me I have to wait 14 to 30 days more for it to be authorized. So the insurance company as well aware that I have an infection in my tooth that is breaking down the bone and I need a root canal and they are allowing me to sit here and just take their time and it will be about two months that I have an infection in my mouth, ruining the bone according to the specialist and I need a root canal.
Business response
01/18/2024
Good afternoon,

Delta Dental has approved and paid for a root canal for date of service 1/4/24. A payment was issued to your provider on 1/12/24.

Thank you
Customer response
01/19/2024

Complaint: 21008492

I am rejecting this response because: ***** care ignored the facts of the actual complaint, based on the dates when I did this. They took an extended time to approve the root canal, and I even had to call again to see if it can be approved. They kept telling me to wait. They eventually after extensive time did approve the root canal, but since then my tooth became infected I had fevers and chills, and I had to start antibiotics because of their delay in care.

Sincerely,

***************************
Initial Complaint
08/07/2023
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.
DeltaCare USA sent me two letters about an alleged grievance that I filed. Case ID ************ did not file a grievance.I have called DeltaCare at the numbe provided in the letter ************. They do NOT answer the phone. I have been on hold for over 30 minutes listening to music.I have no way of know why they sent this to me and why they filed a grievance on my behalf without my approval or knowledge
Business response
08/28/2023
Hello,
After further review it looks like on 7/5/23 you called in requesting to speak with a manager due to speaking with a rude customer service agent prior to this. We apologize this was created without your consent and this should have been explained further to you because of your dissatisfaction.

Thank you
Customer response
08/29/2023

Complaint: 20436135

I am rejecting this response because: I never filed a grievance. Please retract this

Sincerely,

***********************
Business response
09/05/2023
Hello,

Thank you for your response
Initial Complaint
07/24/2023
Complaint Type:
Billing Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Delta ****** was supposed to pay balance of $984.00 of emergency dental services which occurred on 5/5/22. I have a letter from my dentist regarding payment responsibilty for myself and for Delta ******. I got a bill from Rose ****** in February 2023 after they got tired of waiting for payment from Delta ****** and I had to pay out of pocket. The work that was done was critical to my health for a terrible job done by another dentist which cause serious absess and infection in my mouth. I had called Delta ****** numerous of times and was always put on hold for over an hour and having to hang up.
Business response
08/01/2023
Good morning,
Please respond with your enrollee id.

Thank you
Customer response
08/02/2023

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
07/11/2023
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.
We are actively covered by DeltaCare dental (member id *************. My daughter, ***************, and son, *********************, went for a dental treatment on Feb 6th, 2023. One of the procedure (for both kids) was topical application of fluoride varnish, which is coded as "D1206" on DeltaCare handbook. As their handbook indicates, this procedure is at no cost to the enrollee. However, DeltaCare refused to pay the fee and said "This is not an emergency service. We did not receive a request for prior authorization as outlined in the Provider Handbook. Therefore, we are unable to pay for this service", which against their handbook. I called multiple times regarding this issue. Their customer service admitted it was their fault at the first time, but then again refuse to pay.
Business response
07/25/2023
Hello,
This complaint has been received and sent to the appropriate department. Please allow 30 days for review.

Thank you
Customer response
07/27/2023
Hi thanks for helping contact the business. The response only shows that they have received the message and need 30 days to respond. There is not action I can take now based on this message.
Business response
08/10/2023
Hello,
A grievance was filed for your complaint on 7/24/23. Please allow 30 days from the date listed to receive a response.

Thank you
Customer response
08/10/2023
Hi since they will take 30 days to respond, I will wait until 8/24/23 before further request update from them.
Business response
08/29/2023
Hello,

This complaint was responded to and to date we have not received emails in our mailbox ********************************** regarding clarification for this.

Thank you.
Initial Complaint
06/12/2023
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 son needed to be put under for his dental treatment. We used my kids dentist. We had pre authorization for the procedure however now delta care is saying the anesthesiologist is a third party and they won't pay their portion. They are saying my kids dentist didn't get preauthorization for him. My kids dentist is saying they haven't done that in the past and they have at least 6 other occasions where delta paid the claim for those patients. ***** care refuses to pay the claim. You can never get ahold of a manager. They keep giving me the run around. They have been giving my kids dentist Manager the run around as well. They can't pick and choose to pay what claims they want to. If they paid the other claims they need to pay mine as well.
Business response
06/19/2023
Good morning,
Your complaint has been routed to the appropriate department for review.
Thank you.
Initial Complaint
05/18/2023
Complaint Type:
Delivery 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 received a bill from my dental provider. I specifically verified with Delta Dental that full x-rays would be covered, and they denied the claim. This claim was 04/19/2023. My last set of xrays was 12/14/2021. I was told by DeltaCare that the claims are per calendar year. I called in and was advised that I can "write a letter" to appeal, and send it to a PO Box. What a monumental waste of my time. I have never been more disappointed in an insurance company and have spent at least a dozen hours dealing with searching for a provider (your website is highly inaccurate) and actually having the product work. I will absolutely be telling everyone I know about this continued negative experience. DeltaCare USA Enrollee Number ************ Group Number *****
Business response
05/22/2023
Good morning,
Your complaint has been routed to the appropriate department.

Thank you
Customer response
05/22/2023

Complaint: 20074446

I am rejecting this response because:
It does not solve the problem. I will await a resolution from Delta Dental.

Sincerely,

*************************
Business response
05/25/2023
Hello,
The grievance team will address your concerns.

Thank you
Customer response
05/26/2023

Complaint: 20074446

I am rejecting this response because:
Awaiting contact, and will follow up.

Sincerely,

*************************

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