ComplaintsforDelta Dental of Washington

• Initial Complaint

  06/17/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I went to Aspen dental to get a new tooth put in. Delta dental was suppose to pay Aspen dental $2000 (the other half of what I owed) but they never did! Now Im stuck with a $1840 bill from aspen dental that delta dental should have paid! Now its on my collections report and I would like it removed completely.

  Business response

  06/20/2024

  Good afternoon, I have attached Delta Dental of Washington's response to complaint #********.

  Thank you, 

  ******

• Initial Complaint

  04/26/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have dental coverage with Delta Dental of Washington through my employer. I have coverage for myself, wife and two children ages 2 and 4. The plan is an incentive plan in which if you fail to have two cleanings per year, you end up with a 10% co-pay and if you fail to have a cleanings for two years you end up with a 20% co-pay.The problem is, my children did not have teeth or a need to see a dentist for the first two years they were on the plan, being less than two years of age at the time. Because they did not have annual cleanings for two years, they were applied a 20% co-pay which over the last year of cleanings is now a 10% co-pay. I contacted Delta Dental and was told there was nothing they could do because this is the plan. They received two years of premium payments while not having to pay out any benefits and now I am stuck having to pay co-pays for my children dental care to my detriment. I am seeking for Delta Dental to dismiss the mandated co-pays. The incentive plan should consider children under the age of three will likely not have regular 2x annual cleanings and factor that into the plan.

  Business response

  05/03/2024

  Good morning, I have attached Delta Dental's response to Complaint ID: ********. 

• Initial Complaint

  03/04/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My previous dental insurance was Delta Dental of WA through my wife's (***************) insurance plans via her employer. I have been going through divorce with my wife in the past 2 years and she was required by the divorce binding agreement to keep me on her insurance until the finalization of our divorce which happened in February of 2024. I had my routing teeth cleaning with my dental provider on 2/14/2024, before I made the appointment, I specifically called the providers office (*********************, DDS) and they had checked and told me that my dental coverage was still active. Delta dental paid my visit, however, two days after I received the service (2/16/2024), Delta dental contacted my providers office and informed them that my coverage was terminated by 12/31/2023 and withdrew the payment. If I had known that my dental coverage was no longer active by the time I made the appointment, I would not have made an appointment with my dental provider for a routine service. Delta dental failed to update my dental coverage information with my dental provider in a timely manner and subsequently misled my dental provider to give me wrong information about my coverage, therefore, Delta dental shall be hold responsible for the charges incurred during my routing dental care visit on 2/14/2024. After contacting the appeals department of Delta dental twice, they insisted on that their decision of denying the payments of my routing dental visit is correct and will uphold their decision, so I decided to file this complaint to BBB regarding Delta dental WA delinquent on properly updating its clients coverage information leading to the occurrence of uncovered services to its customer and unnecessary out-of-pocket healthcare expenses of the customer, therefore, ********************************************* WA shall be hold completely responsible for the full charges due to its own delinquency.

  Business response

  03/11/2024

  Attached is our response to the complaint filed by ***********.

  Thank you,

  ******

  Customer response

  03/11/2024

   
  Complaint: 21382807
  
  I am rejecting this response because: DDWA attribute the full responsibility to my espouse's employer (they called "group" in their rejection letter), attached is their rejection letter. Both the "group" and DDWA as businesses can retrospectively determine my case, yet as a customer there is no way I can retrospectively undo my received service from my provider. I feel being a minority and discriminated against by the "group" and DDWA in this case, I still strongly feel that either DDWA or the "group" shall be responsible for the payment. If you need more information or any permission to access my protected health or personal information to solve this matter, I will be more than glad to provide. 
  
  Sincerely,
  
  ***********

  Customer response

  03/18/2024

  Please find the attached HIPPA form. 

   

  many thanks, 

   

  Lu

  Business response

  03/26/2024

  Suwai, 

  This is the response we sent to the member regarding this complaint. The member submitted the Hipaa form allowing us to send you a copy of the original determination. 

  Please let us know if you have any questions or concerns.

  Sincerely, 

  Lisa 

  Customer response

  03/26/2024

   
  Complaint: 21382807
  

  As stated in my previous response: 
  I am rejecting this response because: DDWA attributes the full responsibility to my ex-spouse's employer (they called "group" in their rejection letter). Both the "group" and DDWA as businesses can retrospectively determine my eligibility, yet as a customer there is no way I can retrospectively undo my received service from my provider. I have emphasized many times that I contacted my provider's office to confirm my coverage before I received the service which was a routine biannual visit, the service was paid in full by DDWA but later withdrawn by DDWA due to "retrospective eligibility" issues. If I had known that my eligibility was expired before my visit, why would I want to pay a routine annual visit out of my own pocket? I feel being a minority and discriminated against by the "group" and DDWA in this case, I still strongly feel that either DDWA or the "group" shall be responsible for the payment. 

  
  Sincerely,
  
  ***********

• Initial Complaint

  02/20/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  On 9/21 at ********* I had a crown done on a cracked tooth. D2740 on #**. On the day of the procedure, I was told it would be fully covered by Delta H333835**343236363939H of H333339323836**3533**H, and I paid my $25 copay on the day of the procedure. Now I am stuck with a $1,198.00 bill from ********* because Delta H333835**343236363939H of H333339323836**3533**H is saying they do not cover crowns for cracks, as that is preventative.I was already told that it would be fully covered, I already paid my copay, I feel like I am being ripped off.

  Business response

  02/27/2024

  Please see Delta Dental of Washington's response to Case #********. 

  Thank you,

  ******

• Initial Complaint

  01/30/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  As my paid provider Delta Dental oF WA is wilfully denying legitimate ********************** claims as "preventative" and " not medically nessacary " despite dr./ ********************** provider records. Left me as patient on the hook for remaining balance almost a year after time of service. I was not made aware of their denial for 1 year and 2 months after time of service. Refused to review additional information provided by ********************** provider during an 8 month period yet also refused 2 accept a patient appeal because it " wasn't submitted 180 days from time of denial" though I was not made aware of denial within the said 180 day timeframe. Completely ignored my pain and symptoms as a patient as well as doctors provided narrative and x rays. Created a financial hardship by refusing my legitimate claim. I made numerous attempts to work with delta ********************** 2 resolve the issue and provide any nessacary documents to no avail. It is evident they are wilfully disregarding patients claims to get out of paying with no real recourse or options for patients.

  Customer response

  01/31/2024

  ******** denying legitimate claim 9-9-22 declaring existing problem/condition as "preventative" ignored all information sent from provider left me on the hook for the balance. Was not notified of denial until it was to late to file an appeal wich was promptly rejected once I did submit.

  Desired Resolution:

  Billing adjustment; Modification/discontinuance of an advertised claim

  
  

  Business response

  01/31/2024

  Good morning, the complaint overview indicates that the ***** Release was offered and accepted on 01/30/2024. We will need a copy of the release in order to provide our response to the BBB. 

  Thank you, 

  ******

  Customer response

  01/31/2024

   
  Complaint: 21224059
  
  I am rejecting this response because: I have already agreed 2 the release of sensitive information. Another stall tactic by delta dental to further look into legitimate claims
  
  Sincerely,
  
  ***********************

  Business response

  02/06/2024

  Attached you will find our response to the complaint filed by ***********************. 

  Thank you,

  Customer response

  02/11/2024

  Please see attached HIPPA release form. 

  Business response

  02/21/2024

  Thank you for providing the release form. I have attached a copy of the letter mailed to the complainant on February 6, 2024.

  Thank you,

  ******

  Customer response

  02/21/2024

   
  Complaint: 21224059
  
  I am rejecting this response because:
  It is nothing more than the same generic response generated by delta dental from the beginning. Only states all the reasons procedure should have been covered and was refused yet doesn't address any of the issues delta dental is responsible for, as I no communication.  This generic response was replied 2 directly via email. A written copy was also mailed **** directly to BBB and is attached below as well. Delta Dental tried 2 reach out via phone instead of written documentation in an attempt 2 circumvent the *** process.

  After receiving recent correspondence from Delta dental in regards to BBB complaint it is clear that Delta Dental is missing the major issues at hand, and has taken the stance that my Dr. performed a completely unnecessary procedure when i went in with extreme tooth pain in august of 2022. I firmly believe despite being my paid insurance provider Delta Dental is willfully dismissing a relevant claim covered under my plans provisions. while attempting to hold insured to timely technicalities while failing to hold themselves accountable for timely communication of the insured.
  
  
  A permanent crown was placed sept 9th 2022 to repair a large broken filling approximately 35 years old with extreme decay causing pain and inability to eat on one side of my mouth. Once filling and decay was removed there was not enough tooth structure left to simply replace filling resulting in the necessary crown. According to Delta Dental claims records the claim was submitted by provider to Delta Dental in a timely manner a total of 3 times over the course of one year and four months and Denied each time. According to my Provider additional and more thorough information was added to the additional claims however appears to have been ignored/dismissed as "already processed on a previous claim" when it was submitted and promptly denied. During this process i received zero communication or notice my claim was denied from Delta Dental. In fact I was not made aware of an issue until i received a bill from my provider. I promptly submitted Delta Dental Appeals form in which all this information was included but was never read and also promptly dismissed as "Exceeding the time limitation for submitting the appeal".  Impossible to meet said 180 day time limit for appeal when i was never made aware through any means of correspondence that an appeal was going to be necessary!  In fact I was also only made aware my appeal was denied because i reached out to Delta Dental to check the status of that Appeal, again zero correspondence from Delta Dental in regards to any of this process until i filed a complaint with the BBB. Ironically then and only then did i finally get a letter from Delta Dental in regards to the issue at hand.

  
  Sincerely,
  
  ***********************

• Initial Complaint

  07/27/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Very ridiculous billing procedures. Acknowledged 2 dental surgeries were necessary and in coverage network but refused to cover the 2nd. First agent told me that the dr needs to write off the cost because its easy and in the same area as the 2nd procedure. They wanted the provider to do the 2nd procedure for free. I told the dentist i will just pay for the 2nd out of pocket and the insurance said thats a breech of contract. 2nd agent told me they decided its too much trauma for 1 visit and i will have to get it done in another visit. Even though my dr approved that getting them done on the same visit is perfectly fine. Basically billing wont pay for it, but also wont let me pay for the second procedure either. What wouldve been done monday 7/31 is now being stretched all the way into September. I now have 2 surgeries, 2 rounds of antibiotics, 2 days missed work for surgery and 2 more days missed work for follow up appointments

  Business response

  07/27/2023

  Please find attached Delta Dental Plan of ********, Inc.'s response.

  Thanks,

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

  Customer response

  07/27/2023

   
  Complaint: 20380452
  
  I am rejecting this response because:

  when filing the complaint, there was no delta dental of washington as an option. I thought maybe this is headquarters? Where do i need to send this?

  
  Sincerely,
  
  *************************

  Business response

  08/03/2023

  Attached is Delta Dentals response for Complaint ID: ********

  Customer response

  08/03/2023

   
  Complaint: 20380452
  
  I am rejecting this response because:

  this is exactly what you stated on the phone. You stated that the provider is to eat the cost of the procedure, but you cannot force them to do the procedure. This is a lose-lose for patient and provider. You stated you will be covering it as a separately procedure-forcing me to go through 2 surgeries when I could get this done in one visit if you would pay your share. You said you would pay your share if a separate surgery happened. Makes no sense to me if its covered either way. This is poor patient care and a billing policy nightmare for me. You have prolonged improving my gum and dental health to September and I am very frustrated with this system and the explanations that are being repeated make no sense. Provider should not be expected to perform a procedure for free, especially when you cannot guarantee its completion for the patient. 

  
  Sincerely,
  
  *************************

• Initial Complaint

  02/15/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I purchased a dental plan with a $3,000 out of network orthodontics coverage. The orthodontist we chose looked up my insurance and confirmed my coverage, letting me know that 50% of the treatment is covered totaling $2,272.50, Delta Dental showed that no pre-authorisation is needed. Delta dental refuses to pay over $900. They are telling me that the allowed amount for my area is $1800 and they will only pay 50% of that. They will not disclose where the number is coming from. They are denying the coverage that Im paying for monthly, which is $3000 out of network coverage. When I ask they questions about the allowed amounts, they tell me that as a consumer I dont have any visibility into it and they decide what it is at their discrediting. They are telling me that the average cost for the orthodontist treatment in my area is $1800 when I have 4 quotes, including from in-network providers, ranging from $4200 to $4800 for phase 1 braces. One of these quotes is attached. They are sending me a list of in-network providers but when I call such providers they say they are not in network. Delta dental is dishonest and has breached their contract with me as a consumer refusing to honor the coverage that I am paying for. They also refuse to disclose anything that they will cover in the future while telling me that they will not honor the $3,000 out of network coverage that I am paying for. I need to start a second orthodontists treatment for another member of my family, and delta dental will not disclose how much of the $3000 out of network coverage they will honor. Their negligence is costing my family thousands of dollars, not only in the benefits I should have but also in fees that Im paying for my insurance.

  Business response

  02/21/2023

  Please find Delta Dental's response to this complaint. Please let me know if you have any questions. Thank you, ******

  Customer response

  02/21/2023

   
  Complaint: 19413138
  
  I am rejecting this response because:

  - Delta Dental states "to determine acceptable allowable fees for each procedure or service, each state is divided into several socioeconomic
  geographical locations using the boundaries of local dental societies. Fees are based on the fair market value for each
  socioeconomic geographical location." however We live in the high cost living area where the fees are typically higher than other parts of the country.

  - I have attached a quote from the orthodontists that Delta Dental claims to be in network and the quote is consistent with that of the orthodontist of out choosing. Proving that their "allowable" fee is not based on the fair market value as they claim

  - Delta dental claims that there are in network orthodontists available in my area, however they also give a disclaimer on their website that it's on me to determine whether they are truly in network. I called 4 orthodontists within a 10 mile radius of me, 3 of them said that they are no longer in network because of Delta Dental's unfair practices. The last office does not practice modern technology, and I could not trust our care to them. Traveling any further would cause a significant expense, missed school and other hardship for our family. When I brought up this point to Delta Dental, they were rude and dismissive. 

  I do not accept the response as Delta Dental does not offer any resolution to my claim

  
  Sincerely,
  
  *******************************

• Initial Complaint

  12/29/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  ****** refused to answer my question. You don't need a code to tell me if it's possible to cover retainers in general! Poor customer **********************!

  Business response

  01/05/2023

  I have attached a letter for complaint ID ********. Thank you

• Initial Complaint

  12/07/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Delta Dental provided my dentist with incorrect information. Dentist was told that my cleaning would be covered. Dentist was told at time of claim that I was not covered and would not be paying the bill.

  Business response

  12/15/2022

  We have attached the determination letter for you review. Thank you, ******

  Customer response

  12/15/2022

   
  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

  12/04/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have different coverage for my dental care and requested Delta Dental to cancel my policy (# ***********) but DD ignored my request and continued to withdraw the insurance premiums from my account. I want DD to cancel ********* and stop the auto withdrawing immediately.

  Business response

  12/07/2022

  Hello, attached is Delta Dental of Washington's response to this complaint. 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. ↩