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Physicians Mutual Dental Insurance / Not paying claim

Irving, NY, United States

I have been paying for this insurance at the rate of $65 per month for about 18 months. Well into the time limit for crown, root canals, etc. that have a 1 year waiting period. I went to the dentist for a crown and they would not accept this insurance at all. Lucky for me. They did except my Delta Dental Insurance and it paid over $550. They submitted the claim on this Physicians Mutual Insurance and it came back with the claim of $553, they only paid $65. They claimed they did not pay with coinsurance, items not covered, etc. This was nothing be the office call, the Xrays, and the crown. All of which are listed on their schedule of items they pay. Before I went to the dentist I looked all over the policy to see if there was any problem with coinsurance. I could not find one problem with it. I purchased this insurance because when you use other insurance plans, they only pay a portion of the dental work, and I have to pay the rest. I figured with this insurance, they would pay another portion of the dental work, and it would help towards my part of the bill. ABSOLUTELY INCORRECT. They managed to take my money for all of this time, and then only pay one little part of this. I am a little mad. I'm going to file it with the BBB and the Texas Department of Insurance. I think they must have something in their policy to cover themselves with this "coinsurance bit", but it must not be easy to find. Well, I'm going to cancel this insurance because since I could only find dentists that accepted the Delta Dental Insurance, and not the Physicians Mutual insurance, and since PMI has ripped me so good, I don't want to pay them for more. I started to take out their Medicare Supplement, I'm 67, and thank God I did not. I bet it would have been the same problem. They would take my money, and then I would have to fight tooth and nail to get any coverage. DO NOT BUY THIS INSURANCE. THEY ARE COMPLAINTS ALL OVER THE INTERNET. Do yourself a favor and don't fall for this malicious company.

Jo
Jan 9, 2015

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