Complaints

This profile includes complaints for United Concordia Companies, Inc's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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• 

  United Concordia Companies, Inc

  4401 Deer Path Rd Harrisburg, PA 17110-3907

• 

  United Concordia Companies, Inc

  PO Box 69414 Harrisburg, PA 17106-9414

• 

  United Concordia Insurance

  1000 Centre Green Way Ste 200 Cary, NC 27513-2282

• 

  United Concordia Companies, Inc

  2200 6th Ave Ste 804 Seattle, WA 98121-1843

• 

  United Concordia Insurance

  1000 Centre Green Way Ste 200 Cary, NC 27513-2282

The complaint text that is displayed might not represent all complaints filed with BBB. 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.

• Initial Complaint

  Date:10/25/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I filed an insurance claim in June and it was denied numerous times for different reasons. I have contacted this company more than 20 times to resolve the issue and get reimbursed for my dental work. My most recent claim was denied even though I was told these codes would be automatically approved

  Business Response

  Date: 10/27/2023

  October 26, 2023

  Dear ******* *******:
  

  I am responding to your email, which we received on October 25, 2023, concerning the periodontal treatment provided to **** *****.
  

  Due to the Federal Health Insurance Portability and Accountability Act (HIPAA Privacy Act), we are unable to respond with a patient’s protected health information without their written consent. The member will need to resubmit their request with this completed form if you need detailed information.
  

  We will respond directly to the member with details regarding the claim as well as provide a copy of our Request and Authorization for Disclosure of Health Information form.
  

  If you have any additional questions, feel free to contact me. 
  

  Sincerely,

  Senior Specialized Services Representative
  Specialized Services Unit

• Initial Complaint

  Date:10/24/2023

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Customer service team let me know that my policy would be cancelled after 90 days of non-payment. I told them that I wanted to cancel right away and they wouldn't let me and to just let it be cancelled due to non-payment. They advised me not to use my benefit as I would not be covered. in September, we were charged for 5 months all at once - even though, we were told that we would have our benefits cancelled. After speaking with a supervisor, they informed us that there was an internal mistake and that is why the benefits were not cancelled when they said they would be. They refused to give us a refund even though they told us not to use the services.

  Business Response

  Date: 11/01/2023

  Please find the attached response for review. 

  Business Response

  Date: 11/02/2023

  Dear: **** *******,

  The ******* Dental Program (*DP) offered by the Department of ******* (Do*) through the ******* Health Agency (*HA), provides worldwide dental coverage to eligible beneficiaries. UCCI Companies, Inc., (UCCI) administers the *DP for *HA.

  UCCI verifies *DP member eligibility in the ******* Enrollment Eligibility Reporng System (*EERS).
  

  Service members are responsible to ensure their personnel informaon is always up to date in *EERS.
  

  When enrollment is established with the *DP, the contract requires at least 12-month of eligibility remaining in the military under Acve Duty, Reserve, IRR Mobile or Non-Mobile status. Enrollment into this plan is a voluntary enrollment process and a commitment requirement of 12-month enrollment and premium payments.

  All new enrollees will incur a 12-month lock-in period. There is a 12-month enrollment lock-out if the member fails to pay premiums during the 12-month lock-in period or disenrolls for other than valid reasons as specified. Following a valid disenrollment or aer disenrolling subsequent to the expiraon of the lock-out period, an eligible enrollee may re-enroll at any me, with another 12-month lock-in. The TDP enrollment lock-in and lock-out requirements shall take precedence over the contractor’s standard
  pracce. Premium payments are due the 23rd of each month.
  

  Our customers have the option to call in to make a payment via phone, pay their bill online, or setting up automatic payments through their bank account. The online website directs our customers to pay online or to contact us to assist them, either through a phone call or written correspondence. United Concordia Dental then handles each customer inquiry by assisting the member to make their payment by taking the payment over the phone, showing the customer how to use our website properly, or by
  assisting the customer to set up automatic payments.
  

  Our customers also have the option to contact us via telephone, chat, email, or website (contact us form) to advise of a disenrollment from the program. A voluntary disenrollment from the program would occur if the 12-month enrollment period was met. If the 12-month enrollment period was not met, we would not allow the cancellation until the 12-month period was completed.

  It is United Concordia’s intent to provide a quality product with customer sasfacon under the TDP. 

  Please call, 1-************ if you have any addional quesons.

  Sincerely,

  United Concordia
  ******* Dental Program

  Customer Answer

  Date: 11/02/2023

  [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 as Answered]
  
   Complaint: ********
  
  I am rejecting this response because:

  Blanket response - did not even tough on what the issue is or the fact that they admitted to a mistake and refuses to refund up for their mistakes. 
  
  Regards,
  
  *****************************

• Initial Complaint

  Date:10/20/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  have made many attempts to cancel this service and I did not authorize any further charge.since February of 2023. I will dispute these charges with my bank. This company claims to get in contact with their billing department but no response ************ their main office number ************ Their billing agency ********************* ********************************************************************************* They continue to charge me $144.49 monthly sometimes twice a month My contact number is ************ ****

  Business Response

  Date: 10/23/2023

  October 23, 2023 

  Dear ******* *******:

  I am writing in response to a complaint submitted by **** *******, regarding the reimbursement of his dental premiums. We received your letter dated October 20, 2023, the same day.
  Due to the Federal Health Insurance Portability and Accountability Act (HIPAA Privacy Act), we are unable to respond with a patient’s protected health information without their written
  consent. The authorization submitted with your letter has been denied, as there is not a member signature. I have enclosed a copy of our Request and Authorization for Disclosure of Health Information form for that purpose. Please resubmit your request with this completed form if you need detailed information. Written correspondence will be sent directly to the member responding in detail to their concerns.

  If I may be of further assistance, please feel free to contact us at 1-************.
  

  Sincerely

  Senior Specialized Services Representative
  Specialized Services Unit

  Business Response

  Date: 11/03/2023

  We will respond directly to the member on this issue.

  Thank you for advising us of this.

• Initial Complaint

  Date:09/22/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I went to a dental clinic for a severely hurting tooth and was told a root canal or extraction were my options. I called multiple times to verify that under emergency designation I could get a root canal. I received a $2000 bill today for treatment and was told that they never said it was covered.

  Business Response

  Date: 10/02/2023

  October 2, 2023

  Dear: **** *******,
  United Concordia Companies, Inc., administers the Department of Defense's Active Duty Dental Program
  (ADDP) to all eligible Active Duty Service Members (ADSMs) and provides private sector dental care to ensure
  dental health readiness. The ADDP provides dental care to ADSMs who are unable to receive required care from
  a military dental treatment facility (DTF) and provides civilian dental care to ensure dental health and deployment
  readiness. 
  

  The ADSM eligibility is established by either REMOTE or DTF Referred/Direct Care status, which will
  determine if the individual can be seen at a DTF or a civilian dentist for treatment.  In this case, the ADSM is in
  the DTF Referred status (to be seen by a DTF for treatment).  If the DTF was not able to perform the services, a
  referral should be submitted to United Concordia Companies, Inc. for approval to have the ADSM been
  seen/treatment by a civilian dentist.  Here is more information about the ADDP:

  •    DTF-referred ADSMs must follow established DTF emergency dental procedures.
  o    ADSMs who are traveling (leave, duty-related) more than 50 miles from a military DTF and
  have a dental emergency can be treated by a civilian dentist without DTF approval.
  o    If DTF procedures allow emergency civilian dental care, the ADSM doesn't need any
  additional approvals to make an appointment. They may seek emergency dental treatment from
  any civilian dentist. Follow-up care with a non-network dentist won't be approved by the ADDP.
  ADSMs can use United Concordia's Find a Dentist tool to locate an ADDP network dentist.
  •    Emergency dental care for CONUS and OCONUS remote ADSMs doesn't require an authorization or
      Appointment Control Number (ACN)
  o    Emergency Policy for CONUS and OCONUS Remote ADSMs
  ?    CONUS: Remote ADSMs can schedule an appointment for emergency dental care
  with any dentist. A network dentist isn't required, but follow-up care with a non-network
  dentist won't be authorized; the ADSM would be responsible for payment.
  ?    OCONUS: Although OCONUS ADSMs can schedule a dental appointment on their
  own, it's strongly recommended that they call United Concordia for assistance scheduling
  with an OCONUS dentist. They can use United Concordia’s Find a Dentist tool to locate
  a dentist near them.

  If an ADSM is in pain, they may see a provider to perform the necessary care. The ADDP covers emergency care
  worldwide, regardless of the ADSMs status.  Emergency care is the minimum care necessary that is required to
  treat or control hemorrhage, infection, swelling and pain.  ADDP emergency care does not cover, crowns,
  implants, bridges, and dentures.  When emergency care is completed, the provider is required to notify United
  Concordia Companies, Inc of the emergency treatment on the claim that is submitted for the services, this will
  allow a proper claim payment for the emergency treatment. 
  It is United Concordia’s intent to provide a quality product with customer satisfaction under the ADDP. Please
  call, 1-************ if you have any additional questions.
  

  Sincerely,
  ******** *************; CMBS
  United Concordia

  Customer Answer

  Date: 10/13/2023

  I was not informed of a change in price for the crown and if i would have been i would have went on base for it.  

• Initial Complaint

  Date:09/17/2023

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I keep getting letters in the mail saying I have an overdue balance. This company has my billing information, I try to log on and there is no option to just PAY MY BILL. I have to schedule a payment X days before the due date and when I try to pay in advance of the very last day, the button says, "ACCESS RESTRICTED" and will not allow me to save the change. Why, if you have my credit card number, are you not billing me until there are months of arrears?? Why are you sending me letters saying my payments are late and you dont even have an option to just let me pay it?? Seriously the worst online interface and the most frustrating automated phone options. So frustrated with this company.

  Business Response

  Date: 09/26/2023

  September 26, 2023

  Dear: **** *******,
  UnitedConcordia Dental allows numerous payment methods for our customers.  Our customers have the option to call in to make a payment, pay their bill online, or setting up automatic payments through their bank account.  The
  online website directs our customers to pay online or to contact us to assist them, either through a phone call or written correspondence.  United Concordia Dental then handles each customer inquiry by assisting the member to make their payment by taking the payment over the phone, showing the customer how to use our website
  properly, or by assisting the customer to set up automatic payments.
  United Concordia Dental’s customer website process for accessing, maintaining, and managing payments for billing related premium payment services are as follows:

  PAY YOUR BILL ONLINE:
  To get started, simply follow the steps below:
  •    Log on to your My Account using your DS Logon or Common Access Card (CAC)
  o    Select the Billing tab from the menu.
  o    Select the blue Pay my Bill button.
  o    Select Pay Now on the upper right-hand corner of the page.
  o    Select a credit or debit card you have on file.
  o    Select the blue Pay Invoice button to complete your secure transaction.
  Depending on the device used to access this process above (based on the computer, tablets, or phones) may also vary in the type of results you encounter. Experience of the different browser used such as (****** ******, ****, or ******** ********) also pays a part in the experience. You will encounter standard privacy rules and guidelines when attempting an online payment update or to attempt any updates to logging in with new access. 
  How to Set Up Automatic Monthly Payments
  Set up your automatic payments today by following these simple instructions below:
  • Log on to your My Account using your DS Logon or Common Access Card (CAC).
  o    Select the Billing tab from the menu.
  o    Select the blue Pay my Bill button.
  o    Select the Add Payment Method and fill out all of the required fields >select Add payment method >Back to Main Menu.
  o    Select Add Recurring Payment Method.
  o    Choose when you want payments to be withdrawn from your account and when you want automatic payments to begin.
  o    Select any credit or debit card on file you would like to use for automatic payments.
  o    Check the box once you understand the terms and conditions.
  o    Select the blue Set Recurring box.
  If you encounter error messages in the attempt of paying your bill, please be sure that the payment method on file is correct. If the error continues, please contact us so that we my do our best in assisting to get that issue resolved.
  It is United Concordia’s intent to provide a quality product with customer satisfaction under the TDP. Please call, 1-844-653-4061 if you have any additional questions.
  

  Sincerely,
  ******** *************; CMBS
  United Concordia

  Business Response

  Date: 09/27/2023

  The file is now attached for review. 

• Initial Complaint

  Date:08/17/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Im not sure what funny business this company got going on but Idont like it. After carefully reading other reviews I see that I am in the same boat as others and United Concordia not wanting to pay out their portion of claims were entitled to under our coverages. I chose United Concordia through the Federal dental program because i loss insurance through another company due to them not offering it anymore. I have braces and was in mid treatment when i seen United Concordia does " in progress' orthodontics treatment. My plan became effective on 1/1/2023. United Concordia paid a lump sum of 706. 20 only to my dentist on 1/24/23 for coverage of 6 months!! United concordia then only paid out 282.48 to the dentist on 08/22/2023!! After having to reach out and see what was happening they tell me they need to pay out one more and that my treatment was completed. I was like no its not! I still have my braces on and have 3 more months. They have only paid my dentist 988.68 as of date!!! I pay a high premium monthly for this company not to be paying their part. My coverage clearly says they will pay 50% and have a 3000 maximum in network and do work in progress claims.I have until November to when my braces comes off. Why is it that they are paying out little amounts and not fulfilling their obligations. I demand an audit and money owed to me in agreement to the plan i chose and coverage. Yall are defrauding the government and the people and its not right. Make it right. Pictures are attached

  Business Response

  Date: 08/24/2023

  August 24, 2023

  Dear Cynthia Cameron:

  I am responding to your email, which we received on August 22, 2023, concerning orthodontic treatment provided to ******* *******.

  Due to the Federal Health Insurance Portability and Accountability Act (HIPAA Privacy Act), we are unable to respond with a patient's protected health information without their written consent.  We did not receive a completed and signed form providing authorization to release the member's Health Information to The Better Business Bureau.  The member will need to resubmit their request with this completed form if you need detailed information.  

  We will respond directly to the member with details regarding the claim as well as provide a copy of our Request and Authorization for Disclosure of Health Information form.  

  If you have any additional questions, feel free to contact me. 

  Sincerely, 

  Specialized Service Unit 

• Initial Complaint

  Date:06/22/2023

  Type:Billing Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am under my wife's (***********************************************) dental insurance w/ Concordia. Had dental work done 4/12. Insurance should have paid $110. They didn't. Dentist said Concordia told her they mailed check to my wife at home. It never arrived. I called in beginning of May. They said they are canceling old check and reissuing new one. It never arrived. I called again later in May. Told me it was going out by end of month. Two weeks ago my wife says they called her to "discuss" the check and it was being reissued and mailed. It never arrived. I called them back again. They said it wasn't approved yet so I asked for a supervisor since I'm getting lie after lie from them. They told me to hold on an hung up on me. I have heard nothing back. Tired of playing games with them. I had to pay out entire balance out of pocket because balance is now 60 days past due. They owe me $110.

  Business Response

  Date: 06/26/2023

  June 26, 2023

  Dear ******* *******:
  I am writing in response to a complaint submitted by ******* *****, regarding the reimbursement check for services provided on April 12, 2023. We received your letter dated
  June 23, 2023, the same day.
  

  Due to the Federal Health Insurance Portability and Accountability Act (HIPAA Privacy Act), we are unable to respond with a patient’s protected health information without their written consent. The authorization submitted with your letter has been denied, as there is not a member signature. I have enclosed a copy of our Request and Authorization for Disclosure of Health Information form for that purpose. Please resubmit your request with this completed form if you need detailed information. Written correspondence will be sent directly to the member responding in detail to their concerns.
  

  If I may be of further assistance, please feel free to contact us at 1-************.
  Sincerely,

  Senior Specialized Services Representative
  Specialized Services Unit

  Customer Answer

  Date: 06/29/2023

  All it took was your initial inquiry and I have my check. Thank you. How do I proceed and close the case?

• Initial Complaint

  Date:11/13/2022

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I was enrolled into United Concordia on July 7th of this year against my consent. They had my previous information from when I used to be enrolled long ago. I've never needed the insurance and even called a couple months ago to question why I'm even receiving a bill and expressing that not only do I not consent to wanting the insurance, I would like to not be billed for something they have no record of according to their statements. I can prove that I never called on the date they claim I did. I would also like them to pull up the recording calls of me consenting since apparently, they say I called it in. I am still enrolled for some reason and my bill is actually going up even though I called to cancel! How can a company be this unprofessional and rob people against their own will? This is criminal and malicious at this point.

  Business Response

  Date: 11/18/2022

  We are replying to your inquiry regarding coverage for *********************** with the ******* Dental Program.  
  
  Our records indicate that the coverage for *********************** was cancelled on August 1, 2022. We have manually updated the records to reflect this information. We have removed the balance from the member's account and they should not receive any additional statements. We did update the information previously per the member's request and kept getting updates from DEERS. A member's eligibility is verified in the Defense Enrollment Eligibility Reporting System (DEERS).
  
  Please contact the ******* Dental Program customer service department at ************** if you have any additional questions.
  
  Sincerely,
  
  United Concordia
  ******* Dental Program
  www.uccitdp.com
  
  The information contained in this letter may be privileged/confidential and protected from disclosure.  If you are not the intended recipient, you are hereby notified dissemination, distribution or copying of this letter is STRICTLY PROHIBITED.  If you have received this letter in error, please notify us immediately to receive instructions on how to return the document(s).ell us why here...

• Initial Complaint

  Date:11/03/2022

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  There is not a reputable dentist that accepts United Concordia in network in Albany, GA. The list of dentist provided links to one office that has horrible reviews. We are base wide now expected to pay for our own cleanings. The pediatric dentist has stopped in network services beginning 1/1/2023. According to the three offices I have spoken with, United Concordia is the only provider that doesn't pay enough to cover a basic cleaning. We will come out of pocket $180 for one person, one cleaning. This must receive immediate action and attention. Please contact me. *****************************

  Business Response

  Date: 11/29/2022

  November 16, 2022 
  Dear Sir or Madam: 
  The ******* Dental Program (*DP) offered by the Department of Defense (DoD) through the Defense Health Agency (DHA), provides worldwide dental coverage to eligible beneficiaries. United Concordia Companies, Inc.,(UCCI) administers and underwrite the *DP for DHA. 
  We received the inquiring in reference to a lack of available network providers related to the "******* Plan" however it is our ongoing mission to continue to improve in those areas that may be rural or otherwise to the inquiring member. 
  After additional review it's showing that we have approximately 89 of general dentists withing a 35 mile radius of the members zip code and currently 3 pediatric specialists in the area to provide treatment to the member. 
  There has also been a review of the members account & showing no calls or inquiries related to the apposed issue allowing us to assist in the search of a "reputable" provider. 
  ******* Dental Program (*DP) beneficiaries residing in the ***** service areas can receive dental care at civilian dental offices and visit any civilian dentist of choice provided they are appropriately licensed and authorized. However, receiving treatment from a *DP network dentist can save you money and paperwork. You have to ensure the dentist is a *DP network dentist by asking if he/she is in United Concordia's *DP network. All providers will accept your insurance since you have insurance, in most cases a provider will not turn you away. 
  A *DP network dentist has signed a contractual agreement with the *DP contractor to follow *DP rules for providing care and accepting payments. When using a *DP network dentist, you should never pay more than the applicable cost-share for covered services subject to applicable maximums, limitations, and exclusions. 
  United Concordia is committed to helping you find a timely general dentistry appointment within a 35-mile drive of your home. A timely appointment in ***** is an appointment that you're able to schedule within 21 days of your call to the dentist's office. In most ***** locations, there will be at least one *DP network general dentist within a 35-mile drive of your home and you'll be able to schedule a timely appointment. 
  If we can be of further assistance please contact the ******* Dental Program customer service department at ** ************. 
  Sincerely, 
  Heather W****** 
  United Concordia 
  
  

• Initial Complaint

  Date:08/16/2022

  Type:Order Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  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.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  In June I visited my new dental provider. As I was new, they needed a full oral X-ray with bite wings. A month later I received an EOB with bite wings (covered every 6 months) not covered because they were part of the full mouth. And the full mouth (including bite wings) not covered because of a plan limit. United Concordia is refusing to pay for my fully covered X-rays because I had them done at 35 months instead of 36 months. I contacted them and got an “oh well” response.

  Business Response

  Date: 08/23/2022

  August 23, 2022 
  

  Dear ******* *******: 
  

  I am writing in response to a complaint submitted by ******** ******, regarding the denial of bitewing x-rays and a set of complete intraoral x rays on June 30, 2022. We received your letter dated August 17, 2022, the same day. 
  Due to the Federal Health Insurance Portability and Accountability Act (HIPAA Privacy Act), we are unable to respond with a patient’s protected health information without their written consent. The authorization submitted with your letter has been denied, as there is not a member signature. I have enclosed a copy of our Request and Authorization for Disclosure of Health Information form for that purpose. Please resubmit your request with this completed form if you need detailed information. Written correspondence will be sent directly to the member responding in detail to their concerns. 
  If I may be of further assistance, please feel free to contact us at 1-888-898-0353. 
  Sincerely, 
  Jan R***, Senior Specialized Services Representative 
  Specialized Services Unit
  

  
  

  Business Response

  Date: 08/31/2022

  August 31, 2022 
  

  Dear ******* *******: 
  I am writing in response to a complaint submitted by ******** ******, regarding the denial of bitewing x-rays and a set of complete intraoral x rays on June 30, 2022. We received your letter dated August 17, 2022, the same day. 
  ******** ****** is covered under ***** ***** ***. The effective date of coverage was June 25, 2020, under group number *********. The situs of this self-funded plan is in Pennsylvania. The group is self-insured, for which United Concordia provides administrative services only. The State of Pennsylvania has no jurisdiction over this self-funded group plan. However, as a courtesy, I am happy to provide the following information 
  All claims are processed according to the terms of the subscriber’s contract and the information reported on the claim form. 
  On July 01, 2022, we received claim number *********** for dental services rendered to ******** ****** on June 30, 2022, by ****** ***** of Greensburg. Per the benefits mandated by the group, a complete intraoral series of x rays is only covered one time in 36 months. A complete intraoral series is a series of periapical and bitewing images which collectively gives a complete view of the teeth and supporting structures. This procedure shares a frequency with a panoramic x ray, which the member had on July 25, 2019. He would not have been eligible for either of these procedures until on or after July 25, 2022. The bitewing x rays are covered once per 6 months. Because the provider did the x ray on the same date as the intraoral series, the x ray denied for once per 6 months, as the intraoral series has multiple x rays included in the procedure.
  On August 22, 2022, a call was made to the provider to verify the procedures on the claim. The office stated the bitewing x rays were submitted in error, and to please withdraw the service. That same day the bitewing x rays were withdrawn from the claim. 
  This provider is a preferred provider. He has agreed to accept the allowance for any denied service. This means that for the intraoral series of x rays, the member is only responsible for the allowance of $68.52. 
  If I may be of further assistance, please feel free to contact us at 1-888-898-0353. 
  Sincerely, 
  Jan R***, Senior Specialized Services Representative 
  Specialized Services Unit 
  Written correspondence was sent directly to the member responding in detail to their concerns. Please contact the Specialized Services Unit if you have any additional questions. 
  

  
  

  Customer Answer

  Date: 08/31/2022

  [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.]
  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is NOT satisfactory to me. 
  

  Unfortunately, United Concordia is going to play the were just the poor insurance card and will not pay the claim over it being 3 weeks early in a 3 year period.  They will not be reasonable in my appeal and I will clearly not get any actual assistance from them.
  

  What IS satisfactory is that my dental office actually went above and beyond to waive my cost.  

  Regards,

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