ComplaintsforDelta Dental of Illinois

• Initial Complaint

  06/25/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had a dental procedure done 11/2023. My dentist billed Delta Dental a week after procedure was done. Delta Dental refused to pay for almost two years. When they finally agreed to pay, Delta downgraded the procedure that was done to a different procedure so they wouldn't have to pay for the work that was actually done. They also refused to fully cover another procedure done in 1/2023. Every time I speak with them they give different reasons why my claims are not being covered. My Dental office has records of everything they have submitted to Delta, but Delta continues to say they don't have the information needed. Every time we submit the correct information, Delta says they need more or that it was sent to the wrong email. Myself and my dentist have been going back and forth with Delta for over a year trying to get my claims covered. I have appealed their decision.

  

  Business response

  07/03/2024

  July 3, 2024
  
  ******** Relations Advocate
  ********************** of Chicago & Northern Illinois, Inc.                 
  ****************************************;                                                                   
  *******,Illinois 60611
  
  Re: BBB Complaint ID ********
  
  Dear Sir or Madam,
  
  On behalf of Delta Dental of Illinois, this letter serves as the response to the complaint submitted by a Delta Dental of Illinois member on June 06, 2024 regarding payment for dental services.
  
  The member had a comprehensive procedure, involving multiple teeth in a specific area of the mouth,
  and as a result, two treatment dates and two claims.
  
  The initial claim submitted by the member on November 22, 2022 was denied because x-rays were needed for claim review and processing. Following a Delta Dental of Illinois dental consultant review on December 17, 2022, the claim was denied and an Explanation of Benefits (EOB) statement to the member and an Explanation of Payment (EOP) statement to the provider were issued on December 21, 2022,requesting the necessary x-rays.
  
  Subsequently,another service was provided on January 3, 2023. The claim for this service included the necessary x-rays.  Services for four teeth were denied, and an alternate benefit was applied for two teeth.This decision was in accordance with the group contract under which the member is covered and review by a Delta Dental of Illinois dental consultant. This claim was processed and paid on February 15, 2023. Again, an Explanation of Benefits (EOB) statement to the member and an Explanation of Payment (EOP)statement to the provider were issued.
  
  A duplicate claim for the initial service was created on November 22, 2022. The duplicate claim was again denied as an x-ray was required. An EOB (explanation of benefits) to the member and EOP (explanation of payment) to the provider were issued. Following the second denial, the member contacted Delta Dental of Illinois to provide the x-ray, which was used to process the second service.
  
  The claim was sent to a Delta Dental of Illinois dental consultant who denied the claim. The member contacted Delta Dental of Illinois to inquire about the denial and emailed additional information to a ******** Service supervisor. This information was forwarded to a Delta Dental of Illinois dental consultant and the claim was re-reviewed. The denial decision was upheld for two of the teeth involved, but procedures on three other teeth were overturned and allowed.
  
  Payment was sent to the dentist on June 5, 2024 by United States mail. The member was sent a revised Explanation of Benefits (EOB) statement and the provider a revised Explanation of Payment (EOP) statement.
  
  
  Subsequently,on June 12, 2024, the member contacted Delta Dental of Illinois to check on the claim status and was erroneously told by a Delta Dental of Illinois ******** Experience Representative that the claim amount would be deducted from their 2024 annual plan maximum. On June 25, 2024, the member called to express concern that the allowance paid under the claim would be deducted from the 2024 annual plan maximum. At this time, the Delta Dental Illinois ******** Experience Representative clarified that the amount paid for the claim would not be deducted from the ***************************************************************************************** 2022.
  
  We apologize for the confusion caused by the incorrect information provided regarding the claims benefit year. We have addressed and coached the customer experience representative involved. Please know this is not the customer experience we strive to deliver and we thank the member for their patience.
  
  We believe the above information responds to this complaint and concludes our handling of this matter. Should your agency need additional information, please contact **************************************

• Initial Complaint

  06/20/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I have been waiting for a check from them for about two months. I only received one check the other check I never received. I called them once the customer service representative disconnected me when I asked for a supervisor and then she said oh somebody will call me back they did they couldnt do anything. They said all were gonna just send you out a chat. Theyre gonna get processed two weeks and its gonna take seven business days for you to receive it. No timeframe was provided. No nothing else. Provided limited customer service pay for a service not getting the results probably gonna cancel this service

  

  Business response

  06/21/2024

   

  Re: Complaint ID ********

  To Whom It May Concern:
  
  Delta Dental of Illinois is in receipt of your correspondence regarding the above matter. Based on the information included with the correspondence, it appears that this complaint was sent to us in error. We cannot find any record that matches the patient in our systems and the complainant may not be a Delta Dental of Illinois subscriber. Therefore,for Delta Dental of Illinois to investigate further please provide any additional information listed below.
  
  1. Copy of the members ID card (FRONT AND BACK)
  2. Copy of an Explanation of Benefits
  3. Claim number
  
  It is possible the complainant is a subscriber with a different Delta Dental member company in a different state. To obtain information from a different member company you will need to contact them directly. Your time is appreciated with this request for additional information. If the Bureau has additional questions, please contact me at *************************************.

• Initial Complaint

  05/07/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  ID# *********** for the account.My daughter's orthodontist has been trying to get payment for services from Delta Dental of Illinois since 12/05/2022. There was no lapse in coverage and she was covered for $2000 in orthodontic benefits. The orthodontist has submitted multiple claims to the provider to get payment. Forms were submitted on 12/05/2023, 05/31/2023, 11/09/2023, 12/13/2023, and 03/05/2024. Multiple calls have been made to the company in addition to that by both the office and myself. I started calling after the office informed me that the claims were still not being paid. We have been getting a non-stop run around. The first few times I called I was told that the birthday and ID # being submitted we incorrect. I confirmed with the office and also was shown the claim paperwork that contained the correct information. I called Delta on 01/09/2024, 01/24/2024, 02/22/2023, 02/27/2024, 03/01/24 and 04/29/2024. Each time I am told that there is no claim but when I mention the above previous dates...the history for the claim is magically found. On 03/05/24 it was confirmed by *********************** that she got the claim and it was submitted for review on 03/07/2024. I called today and was told that it "may be in the process of being processed and that's why it's not showing on claims". Originally we were told it was a 30 day turn around but today I was told that they are reviewed in order and can take longer then 30 days.I also filled a grievance against the company via their grievance form on the website and have not had any contact.

  

  Business response

  05/15/2024

  Customer Relations Advocate
  ********************** of ******* & Northern Illinois, Inc.                           
  ****************************************;                                                                 
  *******, Illinois 60611
  
  Re: BBB Complaint ID ********
  
  Dear Sir or Madam,
  
  On behalf of Delta Dental of Illinois, this letter serves as the response to the complaint submitted by a Delta Dental of Illinois member on May 7, 2024 regarding payment for orthodontic services.
  
  We first want to state that the members service experience does not meet our standards. The first time the member called on January 9, 2024, they were told no claim was on file for their covered dependent. However, the customer experience representative did not check rejected claims and therefore, informed the member that no claim was received when the claim had been rejected twice.
  
  The claim was rejected because the claim contained an inaccurate date of birth and member ID for the members covered dependent. The claim was received and rejected twice before the member contacted us. A claims processing error letter was sent to the entity who sent the claim, which in this case was the provider.
  
  The provider contacted us on January 11 to inquire on claims status. The provider was also told no claim was on file and resubmitted the claim via email on January 12. Claims processing typically takes up to 30 business days. On January 26, 2024, this claim was also rejected for inaccurate date of birth and member ID. Again, a letter was mailed to the provider informing them of the rejection.
  
  The member contacted us again on February 22, 2024, and was informed that the claim had been received but was rejected because of inaccurate date of birth and member ID. The member stated they were going to contact the provider with corrected information for resubmission. The provider resubmitted the claim March 5, 2024; however, the customer experience representative did not note the incorrect date of birth and member ID. The claim was again rejected March 6, 2024.
  
  Upon escalation, we discovered that in the last claims submission, the provider did include a corrected claim but there were several duplicate claims with the inaccurate information included, as well as documentation of a rejection for this claim after it was sent to another Delta Dental member company and not Delta Dental of Illinois.
  
  Paper or emailed claims can take up to 30 days to process since they must be manually entered into our system. Once input into our system, it can take up to 10 business days for the Explanation of Benefits/Payment notice to be mailed along with payment. For grievances, we contact the providers office within 10 business days to request documentation for review.
  
  To expedite payment, the claim was keyed into our system on May 9, 2024, and the provider should expect an Explanation of Payment notice and payment to be mailed by May 22, 2024. The grievance was referred to **************** and since we have received the necessary paperwork from the provider, the grievance was closed. The member should have received an automated response from our website and will receive a formal grievance letter.
  We apologize for the repeated calls to our **************** department and the delays in claims processing. We have addressed and coached the customer experience representatives involved. Please know this is not the not the customer experience we desire and thank the member for their patience.
  
  We believe the above information responds to this complaint and concludes our handling of this matter. Should your agency need additional information, please contact *************************************

• Initial Complaint

  10/10/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have been attempting to get reimbursed for a dental claim pain for dos 6/14/23 since June, 2023. I have submitted the claim through multiple service representatives with no response and there is no record of the claim on the website after 3 weeks. Request reimbursement of paid amount asap.

  

  Business response

  10/18/2023

  Good morning. Attached is the company response. Thank you. 

  Customer response

  10/19/2023

   
  Complaint: 20719709
  
  I am rejecting this response because:

  I will await resolution of this matter.  In addition, a couple of comments:

  1.  Delta Dental did not notify me by email or mail of the original rejection.  Apparently, there is no process to do this when claims are filed manually.

  2.  The process of filing a claim by a patient is cumbersome, confusing and ****** complex.  I am a physician dealing with billing insurance daily,and found the process crazy. A simple internet based form questionnaire that auto completes the claim form should be in place.  Otherwise, it appears as though the process is made difficult to avoid paying claims.

  3.  The dentist was provided the insurance card but informed us that he does not file claims to Delta Dental.  Payment should be made to me directly.
  
  Sincerely,
  
  *******************************, Md

  

  Business response

  10/27/2023

  Good afternoon. Attached is company rejection response. Thank you. 

  Customer response

  10/27/2023

   
  Complaint: 20719709
  
  I am rejecting this response because:
  After 4 months and repeated calls as detailed in Delta Dental response, the claim was ultimately rejected with Delta Dental claiming that the wisdom tooth removal should be billed to medical insurance and,once rejected, resubmitted to Delta Dental.  It would be funny if I had not wasted over 10 hours dealing with this issue.  At no point during all communication with Delta Dental was this issue raised.  I have filed a complaint with the Illinois ********** of ********* regarding this blatant consumer fraud and deception.  
  Sincerely,
  
  *******************************, Md

• Initial Complaint

  10/04/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have contacted Delta Dental multiple times over the past few months to try and understand why my payments are more than the insurance payments if my coverage is 50%. I was told by Delta Dental: I am showing for ****** and ******* your patient responsibility is $2085.58 for each child, delta has paid the full ortho benefit of $2000.00 for each child.But when I sent the attached documentation showing I'm paying nearly $4k per child, I got no response.

  

  Business response

  10/13/2023

  Morning. Attached is the company response. Thank you. 

  Customer response

  10/13/2023

   
  Complaint: 20695047
  
  I am rejecting this response because:

  Please see attached correspondence from the customer service department indicating my patient responsibility per child was ~$2k.  This is inconsistent with what is noted in the business response.  I also do not follow what they are stating in the letter as to what they are suggesting needed to be done to get this resolved.
  
  Sincerely,
  
  ***************************

  

  Business response

  10/18/2023

  Good morning. Attached is the additional company response. Thank you. 

  Customer response

  10/19/2023

   
  Complaint: 20695047
  
  I am rejecting this response because:  Delta Dental acknowledges providing me misinformation but does not provide any resolution for the misinformation.
  
  Sincerely,
  
  ***************************

  

  Business response

  10/25/2023

  Morning. Attached is the company response to the additional rejection. Thank you. 

  Customer response

  10/25/2023

   
  Complaint: 20695047
  
  I am rejecting this response because:  No resolution was given.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  10/02/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Delta mailed document stating uncashed check issued. My records indicate that I never recieive check . Faxed all neccesary paper work back on July 24th. I have made 3 seperate phone calls for explanation when they will be issuing new check . These phone calls where made 8/3,8/31 and 9/25. There explanation is that you in line and no specific date of when check will be issued.Also asked to talk with supervisor and said they would call back , no phone call back.Please let me know when check will be mailed out .

  

  Business response

  10/13/2023

  Good morning. Attached is the company response. Thank you. 

• Initial Complaint

  09/11/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I have outstanding uncashed checks from 5/27/20, and 5/20/20 that still have not been issued by Delta Dental. I have notified Delta Dental at ************ and faxed ************ at least 5 times by fax, letter and phone. They do NOT respond. It has been years now and they have not sent checks. They keep saying they will send them. I have tried calling customer service line multiple times, but get excuses and the run around information. I have called asking for a supervisor to contact me so I can figure out why the claims are not in the system and they don't return calls.

  

  Business response

  09/20/2023

  Attached is the company response. Thank you. 

• Initial Complaint

  07/01/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  We have received harassing letters for now the 5th time stating that there was a claims error and that an overpayment for the amounts of $190 and $208 that was supposedly sent to us by check. (CLAIM ******************************** We received nothing. NOTHING. I have called them on 4 separate occasions and have been told to disregard the letters and that nothing was sent to us or cashed by anyone and that the issue has been resolved between their office and the dental office. You keep saying that nothing more will be sent to us. That unfortunately is not the case. In fact not only are we still getting these letters, the verbiage is getting harsher and more threatening (FINAL NOTICE...ETC). We are contacting a lawyer to handle this situation moving forward. This is a complete waste of my time to have to go to these lengths and I expect to be fully reimbursed for legal fees after this nonsense is over.

  

  Business response

  07/10/2023

  Re:BBB Complaint ID ********
  
  Dear Sir or Madam,
  
  On behalf of Delta Dental of Illinois, this letter serves as the response to the complaint submitted by a Delta Dental of Illinois member on July 1, 2023, regarding correspondence they received from us on claims overpayments.
  
  We first want to state that the members service experience does not meet our standards. Both claims were initially processed as out of network and according to policy, payment was sent to the member rather than directly to the dentist.  On April 6, 2023, the claims were adjusted since the dentist the member used is a Delta Dental network dentist and the dentist was paid directly for the claims. This is the reason why the first overpayment letter was sent to the member on April 12, 2023.
  
  The member first contacted us on April 21, 2023, because they received the overpayment letter. The member stated they never cashed the check, and our customer experience representative confirmed a stop pay was issued for the check. The customer experience representative then followed our process to remove both claimsrecords from the overpayment list, which would ensure the member would not receive another letter.
  
  On May 16, 2023,the member called again stating they received another overpayment letter for these two claims. The customer experience representative reviewed the overpayment list and confirmed the claims were removed.
  
  On July 3,2023, the member called again stating they received another overpayment letter on June 30, 2023. The call was escalated to a supervisor who assured the member that they will not be receiving another letter from us about these two claims. The customer experience team also responded to the email the member sent with the same information.
  
  Upon escalation, we discovered that an internal team missed the processing worksheet for the week of April *****, 2023, which is why the overpayment letters continued to be issued to the member. We have confirmed with all teams connected to the overpayment process that these claims are removed, and the member will not receive further overpayment notices related to these two claims.
  
  We apologize for this error and the repeated letters going to this member. We are reviewing our overpayment letter process to ensure this type of error does not recur.
  
  We believe the above information responds to this complaint and concludes our handling of this matter. Should your agency need additional information, please contact **************************************

• Initial Complaint

  05/19/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Had a dental procedure done. I do have 2 dental insurances. I had called both my primary - delta dental of illinois and my secondary - delta dental of ********* prior. I was told by both that the billing for the procedure had to be filed first with my medical provider. Then once it was denied - the bill could then be filed with my dental insurances. I had to pay out of pocket for the dental procedure. It was for a crown lengthening. The date was on 11/21/2022. First attempt for the insurance was filed by **************** and the response was that my delta dental of illinois policy was not valid. That is incorrect, my company changed dental insurance the first of year, I absolutely had coverage. So, **************** filed again and it was denied again.Meanwhile my secondary insurance paid $583.20 on 01/25/2023.As you can see in my documentation, 01/17/2023, **************** sent in the request to dd of illinois again. On 01/17/ 2023 ***** from Delta Dental of illinois hung up on me. On 02/13/2023 I was told my claim was still in review by ***** at dd of illinois and ****** of dd of illinois. On 02/22/2023, ***** from dd of illinois told me my claim was just going in to review even though I was told a week prior it was going in to review. On 02/28/2023 ******* from dd of illinois told me the claim was denied and to re submit the paperwork. On 02/28/2023 **************** did. ******* stated they needed additional information and that was why the lengthening was needed. ****** from dd of illinois also reiterated I would need to appeal the decline in my insurance but everything has to be mailed, no fax or email. At this point, I had my primary dentist write a note why the procedure was needed. I mailed everything to dd of illinois. I was denied again and spoke with ****** who told me they never received my mailed explanation from my dentist. ****** then said she would accept a fax, ********** office faxed - initial dentist - I was denied again and told to appeal. I am owed $340.00.

  

  Business response

  06/05/2023

  June 5, 2023
  
  Customer Relations Representative
  ********************** of ******* & Northern Illinois, Inc.                 
  ******************, Suite 2000                                                                     
  *******,Illinois 60601
  
  Re: BBB Complaint ID ********
  
  To Whom It May ****************** behalf of Delta Dental of Illinois, this letter serves as the response to the complaint submitted by a Delta Dental of Illinois member on May 19 regarding the processing of their insurance claim.
  
  We first want to state that the members service experience does not meet our standards. When the member contacted ** in September 2022 about the procedure,our customer experience representative erroneously communicated that the member needed to receive a denial from their medical carrier. We are reviewing our training and coaching policies to ensure this type of error does not recur.
  
  In review of the BBB complaint, the member states they had two insurances.According to our system their spouse has other dental coverage. Based on coordination of benefit rules, the spouses coverage is secondary and the members Delta Dental of Illinois dental plan is primary (please reference the included coordination of benefit explanation for more information). Based on the members claim history, Delta Dental of Illinois did not send an Explanation of Benefits (EOB) with a claim denial citing no dental coverage.  
  
  Delta Dental of Illinois received a pre-treatment estimate of benefits from the members dentist on September 29,2022, which was denied on October 20, 2022. The reason cited on the denial stated that the documentation submitted with the pre-treatment estimate of benefits does not support payment under the members dental plan in accordance with the payment policies for this procedure. The member received treatment November 21, 2022. 
  
  The member contacted Delta Dental of Illinois on January 17, 2023, and was advised that the pre-treatment estimate of benefits is not an actual claim, but that they could submit an appeal on the denial. The appeal was received January 30, 2023. In the meantime, Delta Dental of Illinois received the actual claim for this service on January 24, 2023, and it was denied on February 8, 2023, for the same reason the pre-treatment estimate was denied.
  
  The member contacted ** five times in February 2023 about the claim and payment. Each time, the member was told the claim was still under review. Subsequently, at the request of the members group contact, the claim was reviewed again, and again denied on February 25,2023.
  
  On February 28, the fifth time the member called, we advised them that their dentist would need to send more supporting documentation. On April 4, 2023, the member called inquiring why the claim keeps denying. The member was informed that supporting documentation requested on the February 28 call was not received.  As a courtesy, our customer experience representative provided a fax number for the member so that the dentist could fax the necessary documentation.
  
  On April 7, 2023, Delta Dental of Illinois received additional documentation from the members dentist. The claim was again denied.
  
  On April 14, 2023, the claim was reviewed externally by a third-party dental consultant as a result of multiple reviews. The external review upheld the original denial, and the denial was sent to the member April 26, 2023.
  
  The supporting documentation provided by the members dentist did not meet our processing guidelines for the treatment the member received, and therefore, the claim was denied and that denial upheld.
  
  The appeal process can take time as thoroughness is vital to the review; however, the member and dental office should be given a thorough explanation as well.
  
  We believe the above information responds to this complaint and concludes our handling of this matter. Should your agency need additional information, please contact **************************************

• Initial Complaint

  04/05/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I filed a claim for reimbursement , due to going out of the country for treatment. The claim was denied due to the need of xrays. the xrays have been confirmed recieved by Dental dental on several occassions. I cannot get anyone to tell me the time frame , what the hold up is, what they are waiting for etc.. now again as of the 29th they denied claim claim saying they have no xrays even though the xrays are there. I cannot speak to anyone in claims, any manager and cannot get anyone to care enough to do anything to help me on this claim

  

  Business response

  04/07/2023

  Please read the attached company response requesting additional information. Thank you. 

*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. ↩