Delta Dental Plans Association

On June 8, received dental services from an out of network provider and submitted bills in June 2023. According to the Delta Dental, they issued a check for the claim to me, which I never received. Since then, I have called them 5-6 times. The customer service told me, that the original check was never cashed and Delta cancelled the check, and a new check for the claim would be mailed to my address in August 2023. To this date 9/25/2023, the check has not been issued by Delta Dental and I have not received the new check for the original refund due. It is very frustrating even after making repeated calls over the last three months.

Delta refuses to provide a EOB to me in order to file for reimbursement with my secondary provider. They lie and contradict themselves. First they tell me that they do not produce EOB’s and then they tell me to ask the provide for a copy of the EOB because they send one to the dentist. So do they or don’t they produce an EOB? Well, my dentist told me that they do produce an EOB but they told me it is not their practice to provide the document to me and I need to obtain the documents from Delta. Again, Delta refuses. They tell me to provide a print screen to my secondary insurance to attempt to get reimbursed. This document is not sufficient to submit to the secondary insurance. Delta HMO dental is not an insurance provider. It is a “discount” program and it misrepresents itself and also does not provide any type of member service or support.

I had a procedure done on March 23,2023 for $4715 which I had to pay for up front out of pocket for three teeth. There have been three claims filed for the same procedure. When I got the explanation of benefits it said local anesthesia wasn't covered. Okay I get that. My dental office resubmitted the claim and it looked like it was going to pay $900 and something then just showed it had processed and still paid nothing. I have been back and forth with my dental office and they have sent everything they can. I also have a secondary insurance but waiting until my primary pays first before they will. I am LIVID with this company since they pick and choose what they want to pay! I am SO READY to dump this insurance!

Claim numbers: [protected], [protected] and [protected].

Delta Dental is my secondary dental insurance. For multiple occasions I submitted a claim for a tooth implant and 4 times I got the same denial even after I sent all of the required documents voa certified mail returend receipt.

I even submitted a verbal grievance via the agent and just received the letter that Delta Dental does not accept verbal grievance and I need to have a written one. This is beyond frustrating to deal with this company. I made several calls and every time I hear different stories. One agent said that my claims were not processed correctly and that they have all necessary information but claims still got denied for the same reason - missing promary insurance information. Second tine I called - the agent did not speak clear English. Third time I got an agent on the call that gaveme an e-mail to send a package that was sent to the insurance together with the claim and she said she mailed it to the Claims department directly. Stil nothing is happening on my patient portal. How could I get this company to do their job?

Refused to cover an implant on the grounds that they "do not have a record of extraction and, therefore, it's a defect the patient was born with." They even supplied a conclusion from a "doctor", someone who doesn't know that if the tooth has never existed, the adjacent teeth would move/expand, and the gap would close which would not allow to install an implant.

Crooks.

Signed up for the Premium Dental plan. I required dental surgery rather quickly after moving to a different state and in my hunt for an insurance plan without a waiting period, a website claimed delta dental was offering such a deal. I spoke to supposedly a 3rd party phone service that said "Yes this is a current deal. Most companies don't offer no-wait periods to prevent people taking advantage. How we get around that is we offer 40% coverage for the first 6 months and after 12 months can be as high as 80%." I signed up, scheduled my surgeries and found out the day before I wouldn't be covered at all, $1400 out of pocket. I'm keeping the insurance to show I'm not trying to take advantage. I've already written two grievances with the company and for both they took no responsibility for the blatant misinformation and was unable to give me information on the employee since it was a 3rd party registrar. It concerns me that he had such a pitch put together on it that maybe they're being trained this way and possibly scamming more people. I know things are tough these days but too many companies are getting away with lacking accountability, this whole situation makes me uncomfortable and I rarely get involved with disputes.

While I appreciate the customer agents who handled my inquiry properly, I disappointed that I had to deal with agents with some behavioral issues. One female agent was really emotionally unstable, and made me scared to call their service again. Delta Dental looks like they want their customers to contact them by email, rather than calling them and I like this email-based communication, especially if their customer service agents have some health issues.

I am a very unhappy 😒 customer who have had some negative dealing with your associates. It started when I tried to re-enrolled in an individual dental plan after being a client since 1980. I just retired from my job in November and filled out an application on line with the help of Melissa on February 2, 2022. That went well but the calls after was like a runaway train. No one understands what I was talking about or what my need was. I had four individuals with your company passing me from one representative to another. Each had no knowledge of providing me with needed information, an id card, or any person who can answer my question. I was disconnect from another Melissa a few minutes ago after being on hold for more than 45 minutes waiting for some, because she could not find a Manager or Supervisor. I filled out an application in February and bank information. I need an id card. I know we are experiencing a pandemic but the web is not. Clients should be respected and treated as such. If you have an answer please respond. Thank you.

Deceptive and very misleading policy coverage of Delta Dental...

Let me put this into perspective. I paid almost 2k out of pocket for a dental crown/build up, as I had to see a prosthodontist because the tooth was a front tooth. Because I had to see this specialist and this specialist does not work with insurance. However, I can submit a claim. Fair enough. I called Delta Dental and was given quotes and amounts for the coverage my policy provides. Had the work done and then submitted my claim.

I expected around a certain amount to be covered with the information I had received and what is listed as my coverage. To my surprise my "covered services" really were not as such. I received a check in the mail for 446$ This is what Delta dental paid out of the $2, 000.

Since this encounter I have spoken to Delta Dental and was given more detailed information and explanations as to why the insurance check was minimal.

Come to find out that when my insurance coverage says that the insurance pays such/such % for out of network providers...it does not really mean they cover such/such % for out of network providers. I have learned what this means is that "if you use an out of network providers the insurance company will only cover the "average" cost of service in your area. "

Doesn't sound too bad right?

Wrong- the insurance ( Delta Dental) will really only pay a "portion" of the average cost of services...

I ask: How do they get the "average cost of services in the area?"

Great question was answered as such, Delta Dental gets the average cost of services by comparing in-network contracted cost for services to what the out of network provider has billed for services.

Hmmm, this does not sit well. This means the insurance company (Delta Dental) takes the "average" cost of services from the fixed contracted prices Delta Dental has already has set with the providers.

Bottom line is Delta Dental not only gets to set the contracted prices for services (which are typically an lesser cost) but Delta Dental gets to use their own "contracted prices" to determine the "average" for cost of services with an outside provider.

So is this considered a monopoly or double dipping ?

Outdated, Stagnant Reimbursement fees over 10 years old are still in place, without the option to negotiate an increase. Dental service reimbursements have improved from other networks to help with the huge increased costs in operating a dental office and providing dental care to patients. The huge, huge recent cost barrier trend now is the hourly rates being requested for auxiliary staff such as dental hygienists, assistants, and office personnel. We need an increase in the reimbursements to help support the requirements to staff a dental office in order to continue providing dental benefits to the beneficiaries of Delta Dental. Delta Dental refuses to negotiate and/or increase their PPO fees. Our office is writing off on average over 50% on each claim sent and received, and we are meticulously price set in the lower 25-33-50th percentiles, provided from national statistical data for our industry and geographies. We are unable to get temporary RDH coverage for our offices to even cover our preventative hygiene schedule load. If you are able to arrange for a temp, the going rate is $60-$66+ an hour, when RDH's are requesting 1 hour appointments, and Delta Dental is reimbursing $43 for a prophylaxis/cleaning. In due fairness, an RDH may take Bite-wing X-rays on 50% of recall patients, and maybe provide a Fluoride treatment to 50% of Pediatric patients additionally, which are also very small reimbursements for the dental services coming from Delta Dental. This will not work for much longer, why does Delta Dental refuse to negotiate these decade old reimbursements, especially NOW, when they are aware of what is going on in the industry . There are many additional costs involved with providing these benefits other than an RDH's hourly rate, Front Office Staff, Office Managers, supply costs, technology and instruments, X-ray equipment and systems, buildings, insurance, IT, systems, maintenance and repairs. Delta Dental has to reimburse more than the decade old+ contract that they refuse to raise. Additionally as an auxiliary complaint, their Provider relations department says they do not negotiate, and that the only means to further request a complaint is to utilize their Provider Dispute Form, Now called a Provider Inquiry Form, and to send it in with a request of a maximum of 20 identified priority codes you are asking to be reviewed. This process has been utilized more than one time, AND THEIR DUTY, AS THEY HAVE STATED ON THE FORM ITSELF, "DELTA WILL ACKNOWLEDGE RECEIPT OF YOUR DISPUTE WITHIN 15 WORKING DAYS AND SEND A WRITTEN RESOLUTION TO YOUR DISPUTE WITHIN 45 WORKING DAYS.", has NOT been afforded and upheld by Delta Dental. They have not responded one time to the complaint forms sent either, which we were advised as the only means.

I have cancelled my Delta Dental plan because (1) their network is virtually non-existent in the DFW metroplex and (2) their reimbursement rate is so low that its cheaper for me to put the premiums in a savings account and just pay cash for services. I have no doubt that the reasons that the Delta network is small in our area is because they pay providers so poorly!

Please consider a new Dental plan that provides decent coverage - United Healthcare, Aetna, Physicians Mutual, etc. all have them and offer much better coverage for much lower cost. Please don't let what Delta is willing to pay AARP for the abilty to be "the chosen one" to be the reason for selection. Your members deserve better!

I have been in contact with delta dental by phone and email. By phone was a "disaster" as rep on phone tried to talk me out of complaint stating I was not billed and yet bank account shows I was (autopay feature). I complied withier stringent rule: you have to submit a letter in writing via US Postal Service, I did, received a letter back stating confirmation of account closed. Then I filed a complaint with BBB.. got a run-a-round from Delta dental asking me to prove I received a confirmation of account closure and asked to submit a copy of confirmation letter (they have no procedure to search their own records it appears). I did that only to receive a notice they could not read the copy of their cancellation letter. Obviously Delta Dental has implemented procedures to obfuscate complaints.. their over-all rudeness is enough to make one want to stage a sit in protest at their headquarters... just to expose them for their fraudulent billings. There should be a class action suit filed to recover losses with punitive damage awards for stress and frustration rendered by their lack of concern for customers. Delta Dental is just another scamming company.

i have had them since 2 years anypaper work submited.will not come back.If seniors have to deal with them al llong aarp should not consider them at all.I have been dealing with the loyalty team no response.
AARP® Dental Insurance Plan
Delta Dental Insurance Company
P.O. Box 2059
Mechanicsburg, PA 17055-0759My policy nos is [protected].my phone nos is [protected].
this is their address.they dont have a grievance addresal site.

On 10-26-2015 I called AARP Delta Dental to pay my monthly premium of $58.78. The representative took my credit card information over the phone but incorrectly added $117.56 which I did not find out about until the next morning (10-27) when I checked my checking accont online. I immediately called Delta Dental and a rep said she'd get the $117.56 refunded ASAP by sending a request to the supervisor in the billing department. I told her that the extra unwarranted amount had overdrawn my account. She said Delta Dental would pay any overdraft fees. I had been led to believe that a refund check would be sent to me immediately after a supervisor approved the refund. On 11-04 I called back since I hadn't received a check. The reuqest still had not been signed off on by any supervisor and of course no check had been sent to me. I spoke to a member of their "Loyalty Team" who said she knew someone in that department and would try to get the sign off expedited. It is now 11-09-15 and nothing has happened! This is unconscionable! Jofannie Karla Enrollee ID: [protected]

I had tooth and gum pain that began in mid-May. I have been struggling with it since. My gums are very inflamed, red and swollen, making it very difficult to talk and eat. I have not been feeling well because of it. Sometimes, I feel like I'm running a fever because of it and feel tired a lot of the times. I have also been breaking out into little red hives, which started soon after the mouth pain, so I think they're related. I had an appointment with my periodontist today. I had taken a sick day from work because I did not know what was causing the inflammation and pain, and I expected whatever needed to be done was going to be more extensive than just a regular cleaning. My periodontist first took x-rays, then measured my gum pockets, and did a regular cleaning to determine if I needed a root planing. Based on the results, my dentist said that a root scaling was needed. They could do half the first time, and then the other half the next. I said I am willing to have the first half done today, if they can fit me in their schedule. I have already been in enough pain, and I did not want to wait any longer. They looked and said they did have time today. S0 I ate breakfast, ran a few errands in between appointments. I come back and the receptionist informs me that they have called Delta Dental to see if it was OK to do the root planing today. They told her they wouldn't cover the root scaling today, and that I would have to wait 90 days before I could have it done, if I wanted them to cover it. My root planing without insurance would cost me $800.00. With the insurance, it would have been $140.00. Big difference in cost. I was really disgusted with this decision, and decided to call the Delta Dental myself and complain to them. Delta Dental told me that this was their policy. I asked them what is the basis for this policy, and they couldn't give me an answer. I said the doctor and I have already determined that I need this root planing as soon as possible, so why the 90-day rule. I told them it shouldn't be up to you to decide if and when I receive care, especially when you are not the one who's actually providing the care. I told them this policy allows for negligent care, and that I would complain to the Better Business Bureau, and even sue them if that's what it came down to. Still they would not budge, and only thing they did was provide me with an address I could mail a complaint to. I am so angry with them. What if I had oral cancer and the insurance company just decided that I'd have to wait a year to have anything done about it. Think about that one. What right do insurance companies have in telling patients how long they have to wait before getting treatment? Having to wait for care is just plain ridiculous!

On more than one occasion claims were submitted to Delta Dental of Rhode Island and on more than one occasion there was a refusal to pay with tons of double talk on their part. A claim was made for the balance of orthodontia work. They cover this work, but the work was started by Met Life and they used the excuse that because we started with Met Life, Delta Dental would not pay the remaining few hundred dollars. They said if we had started the work with them they would have paid the balance. Does this make any sense? The next problem was they would not pay for a root canal evaluation because they said I had one this year. It costs $85.00 and my balance for the year is between $600 and $700. What difference does it make if I had one for the year. I have the allowance so why can't I use it? My husband had periodontal scaling done, but they would not cover it because they said he had no history of gum problems. How is one supposed to have a history of something if they cannot begin one? I have never had issues like this with other insurers. I feel that whenever a reasonable claim is made this company is going to throw a monkey wrench in and not pay up. What does one do? We pay premiums and opted for the "best plan" they offer and this is what we get. Unfortunately, we do not have a choice in the matter, as this is what my husband's company offers. What will the next denial be?

joined delta dental not knowing how they work the system i pd them 99.04 on 11-25-09 then 49.52 a mo i never got my package till jan told them were to send 2x then i found out you still have to pay a bal at dentist office so your not really getting a discount never used any of it i canceled on jan5 10 they never canceled till feb 1 10 so they said sent refund 49.52 only witch i shood got the 99.04 also so they sent ck only 49.52 4wks ago never got called 4xs now they want to trace and cancel ck and send another one witch wiil take another 2to3wks figure that one they can take out acc but cant put it back not right a rip off buyers be were

This has been an ongoing complaint with this insurance agency and no matter who you complain to and this includes the state dental board, Nothing changes,
My spouse is a federal employee for the USPO and Delt Dental continues his payroll deductions and has not paid for my Oral surgery by their preferred Surgeon. The surgeon wants his $600 and is threating collections!
Delta dental is aware and not responding and I have no front 4 teeth for almost 2 years now!

I have Delta Dental in Calif. I pre-determined Dentist was a Preferred Prov. which allowed me abt $450.00 of coverage. I get bill, turns out they are not, and I am out of benefits, I am charged the FULL amt. Office staff said they did not call Delta before treatment, I feel this tactic is a rip off becuase it's a way of making a lot more money, just make the consumer PAY! Which agency in Calif can help me? Where do I go to report them?