[Resolved] DentaQuestdenial of services

Review updated:

DentaQuest is the carrier selected by Fla Healthy Kids which covers children up to age 19 in our state. My daughter was given a referral from her dentist to have her wisdom teeth out. After weeks of phone calls which gave me misinformation I finally got approval to take her to an Oral Surgeon. The surgeon sent her xrays and a report to DQ stating she was having headaches, inflammation and all 4 teeth were impacted. DQ denied the upper teeth and only approved the lowers.See the Top 10 Worst Complaints in Orlando, FL My daughter loses her insurance on August 31st because she turned 19 and DQ has dragged out the approval process horribly. I have appealed the decision but the receptionist said they do this to Kids all the time and never repeal their decision sticking parents for hundreds of dollars out of their own pocket. My daughter will get the lowers taken out next week and probably not be able to do the uppers until much later because we don't have the money to prevent her going through this procedure twice.

  • Resolution statement

    Customer care service did everything in their power to resolve this complaint. All attempts to contact the complainant have failed. Therefore, this complaint has been annulled and must not be considered where image of the company in question and it's services are concerned.

  • DentaQuest Customer Care's Response, Aug 23, 2012

    From DentaQuest:
    We appreciate your feedback and apologize for any inconvenience you may have experienced. At DentaQuest, our mission is to improve the oral health of all, so every person has access to quality dental care. Please contact me directly at [protected] ext 44210 and I will be happy to assist you.

    Kristen Clafin
    Complaints & Grievances Specialist

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  • An
      Oct 16, 2012

    This is now also happening to my daughter! Something needs to be done!

    0 Votes
  • De
      Dec 10, 2012

    You are not alone. It is disgusting that Dentaquest has been allowed to operate this way for any length of time. My son needs 2 teeth extracted. The dentist won't do it - says it needs to be done at the oral surgeon. Dentaquest won't cover the procedure at the oral surgeon. They want me to go to the dentist. But dentist won't do it. And Dentaquest is laughing all the way to the bank. What they don't realize yet is that they've screwed the wrong person. I'm now reporting them to the Florida Department of Business and Professional Regulation, the Florida Department of Insurance and the Florida Department of Consumer Affairs...just to get started. Shame on you, Dentaquest for treating your patients like crap.

    +2 Votes
  • Fl
      Aug 07, 2013

    As I was reading the previous complaints I felt like I was writing it.
    I have been on hold every single day with DentaQuest for an average
    Of two hours each time!! They are constantly making reasons about the
    Referral not being submitted correctly and the dentist has sent 5 referrals!!
    My son is 19 and his coverage ends at the end of the month. He has at least
    One wisdom tooth that needs to be removed. Every referral has been sent in
    As an emergency. Dentaquest does not care about these children. Dentaquest
    Is by far the worst company I have ever had to deal with. I am now down to a week
    And a half before my son leaves for college. What are the chances he is able to get
    To a specialist and have this taken care of?!? Dentaquest you should be ashamed of

    0 Votes
  • Po
      May 08, 2014

    I work for a dental office and ever since DentQuest took over our medicaid program back in October, we have been having trouble getting Wisdom teeth approved along with lots of other procedures. The dentist even called and spoke with one of the specialists at DentaQuest and it didnt make any difference, they still denied the claim. We have sent in all the necessary information which is more than adequate to get theses claims approved. In all my 15 years of filing claims, I have never had the problems of getting the claims approved until now. If you would like to read the first paragraph of page 2 of the following newsletter: . I am apaulled by this information. Unfortunately the children of this generation will not be receiving the quality care they deserve.

    +2 Votes
  • El
      Jan 13, 2015

    I am having this same issue with DQ!My daughter is only 5 years old and will not sit in the chair longer than 30 seconds due to her fear. She suffers from server anxiety and two of her back teeth are rotting more and more all because they keep denying her claim! These guys need to get shut down and sue!!!

    0 Votes
  • Ti
      Jan 23, 2015

    I am also experiencing this problem with my daughter.She needs all four of her wisdom teeth taken out because of extreme pain.she had been taking pain medicine for the past three months due to her wisdom teeth.shame on you dentaquest . I have heard so many complaints about you approving procedures. I believe our dentist and oral surgeons know what the are doing if they say it need taken out then it needs done. we pay for your insurance and you refuse our claims.not a very good practice .she also gets headaches cant eat
    can't focus on her education.I guess that you think our dentist got their degress from a cookie box.A very frustrated mother that wishes that she had the means to pay out of pocket for procedures that are medically needed.instead of having to rely on a insurance company who staes that the care about oral health.bottomline you are greedy and care only about the almighty dollar.

    0 Votes
  • He
      Mar 27, 2015

    My policy went into effect on 1-1-15. Of course I did not receive an invoice until after the first as my account was in the process of being established. I go online, establish an account in January and pay for January AND February. I go to pay my March premium and can't log in. Thought it was just a technical error so I go to the dentist for cleaning and x-rays. They tell them my account was discontinued on 1-1-15 and a refund for the payment of 2 months was in the mail. Now owe the dentist $600 for cleaning and x-rays. ### ###s...your getting reported to the insurance board and an attorney.

    0 Votes
  • Js
      May 28, 2015

    My daughter is missing two teeth plus her teeth are very crooked. The dentist says she needs braces to fill in her two missing teeth. Dentaquest denied her claim for no reason at all. The Missouri state legislature, health care USA and dentaquest have all turned their backs on my young daughter. It appears that nothing is sacred to these criminals. They would sacrifice anyone or anything to save a dollar.

    0 Votes
  • Ju
      Jun 09, 2015

    My 14 old son has been denied braces. His overbite is so bad that it cuts into the roof of his mouth. He also accidentally bites into his lip causing them to be swollen and sore. I am filing an appeal. This has also affected his emotional well being because of this horrific overbite. It is truly ridiculous this claim was denied. I will be filing an appeal.

    0 Votes
  • Ke
      Nov 28, 2016

    @Juan Salgado I am experiencing the exact same issue with Dentalquest. My son is 16 years old he has several overbites and also crowdniess in his mouth. The dentist stated that he does need braces. even notating that on the notes when the xray was sent, My son was denied!! This is unacceptable, i filed an appeal please someone inform me of the next step in which to move forth. This is absolutely horrible.

    0 Votes
  • Ka
      Apr 14, 2019

    @kelzz I am currently going through the exact same thing. My son is 13 with a bad over bite that causes him to bite into his gums. Just got the denial, I can’t believe it because it even hinders his speech. I was wondering how your appeals went?

    0 Votes
  • Je
      Aug 13, 2019

    @KatrinaE My 11 yr old son and I are going through the same thing. He has bad overbite, severe crowding, and jaw pain. I was told by his dentist, his orthodontist, and his pediatrician that braces are medically necessary. Also he has speech problems and has been in speech since 6. I've been denied twice. I honestly do not know what to do. My next step is to ask for a fair hearing, whatever that is. I was also told by his dentist and orthodontist that they have seen kids come in whose teeth arent that bad get approved and then kids like my son who truly do need braces keep getting denied.

    0 Votes
  • Ka
      Jun 15, 2015

    I need to have my wisdom teeth out as they have only half erupted and came in with infections, i am in pain to a point where it hurts to move my mouth. My dentist said the teeth need to come out now before more problems come about. However i have called every single number my insurance provider has given me and not a single oral surgeon accepts denta quest. That's a problem for me because now im having to find a way to pay for this myself, when i have little means of doing so. Why is no-one taking this insurance? And why is the insurance company giving me numbers to people that dont take this insurance? I pay for my insurance and you are not providing, i am extremely upset.

    0 Votes
  • Ja
      Jul 31, 2015

    Is there a class action law suite going against dentaquest.

    +1 Votes
  • Dh
      Nov 03, 2015

    I'm trying to start the process for a bone marrow transplant and they won't do anything until they get clearance from the dentist. I'm fighting Dq right now because they REFUSE to pay they dentist and they have a problem with the dentists codes. The office manager told me that if they change the codes, they won't get paid. So these people are basically trying to KILL me because they are cheap and greedy.

    0 Votes
  • Su
      Apr 21, 2016

    it is ridiculous how horrible the DentaQuest service is. I have been after a referral for my daughter for over 2 months. They continue to put me on hold or on a three-way call with my daughters dentist and continue to have them fax the referral. it has been faxed to them over 4 times to 3 diferente fax number and each time them claim they never received. I've spoken to a Debbie and a Margery and now a supervisor called Katherine Seveño, who put me on hold for over 30 minutes because when the call was transferred no one "Margery" never told her what the call was about. They are dealing with kids lives and have no accountability for what they do. They treat humans in an inhumane way forcing children to endure pain and even infection due to their lack of service. They discriminate against gender and ethnicity, belittling and condescending peoples lives and livelihood.

    0 Votes
  • Jo
      Jan 02, 2017

    What you all need to do is email or contact your governors office with all your problems, keep a track record of each person you've spoken to before you even begin the conversation, get their rep id if they have one, what office location they are out of. Ask them the 900 questions they ask you to identify you, you do the same to them. Get thier info! I can't tell you how extremely valuable this is. Write down the exact date & time they picked up the call. Keep a standard sheet phone log of every single thing spoken about. And most important keep your cool no matter how long and how much hell you go through. Keep your cool. Then you have the ball in your court and contact your governors office with the issue. Contact your councilman office. And any other high rank official you can possibly think of. Local better business bureau. Sit down for around 2 hours and file all the complaints and watch what happens within a day or two. A manager or exec will call you. Do all this only if you have no other choice. If you do in fact have a choice then dont aggravate yourself or waste your time simps go find a new provider. Its a god damn ##### nightmare!!! Thank pos obama for this crap!

    +1 Votes
  • Mv
      Jul 08, 2018

    My dentist is wonderful I had routine cleaning, exam and x-rays . I'm new to medicare and denta quest they have denied my claim which was submitted by the dentist. Not too please when it was part of the policy I enrolled in. What is going on? I will be in touch with medicare as this is starting to smell fishy.

    0 Votes
  • Ms
      Oct 22, 2018
    DentaQuest - No help
    New York
    United States

    Everytime I'm calling in or go to the emergency for help I don't receive help and I have medicaid. When I call in to speak to someone if have long wait or not referred..I need help and it's like what's the point of having insurance and or Medicaid if they don't help u?

    0 Votes

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