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I had a root canal performed on 6/14. I have primary dental coverage through former employer with BCBS, and secondary dental coverage with current employer through Delta Dental. Claim was first filed with BCBS. The endodontist's office then filed with Delta, providing them with the claim statement showing what Blue Cross reimbursed for the root canal. Delta received the claim on July 12. As it appeared to still be "in process," I called Delta asking about the claim. I paid out of pocket for the services when they were performed (almost $1600). I was advised that it can take up to 30 days to process a claim. I then spoke to someone at Delta on July 26 who indicated they needed the date the BC policy became effective (over 10 years ago). I sent that info immediately. They still denied the claim and have now restarted the processing time to allow yet another 30 days.
BCBS paid my claim within 72 hours via direct deposit. What is wrong with these people that it takes a month (or two) to process a claim. They made no effort to contact me to request additional information, so the claim would have just simply been denied. It's off because I had a crown done on July 17, and that was prior to them requesting additional information yet they processed that claim. They are snappy and rude on the phone. If the rude customer service people were out of pocket $1600 for a dental procedure, I'm sure they would like to get their money back in a reasonable amount of time. What's difficult to understand about that? That's what I pay for insurance for. These people are rude, inept and not worth the money paid in premiums. Buyer beware.
Recently most of my claims were denied. When asked, Delta only said that they covered a certain amount of a procedure, despite the Benefits Booklet showing 100% covered in both in-network and out-of-network. When I asked how much is covered up to this "certain amount" the customer service rep told me that they do not know until the claim is being processed. Now I'm stuck with a $288.00 bill for a dental cleaning because these policies are not transparent. How am I supposed to estimate my coverage when Delta Dental maintains an arbitrary internal amount and will not allow consumers access to this so they can make the best choices for their health? Delta Dental is shady and untrustworthy. I would stop using them if our plan allowed.
My 5 year old had a tough time with her teeth as most had some decay. It took 7 trips to the children's hospital to get her teeth drilled, filled and capped. With each session she needed "sleepy juice" to sedate her. On the last trip to fix her front teeth the dentist suggested we try scaling back the decay since she'll soon lose her front teeth. I thought this was a wise, less invasive choice and was hoping to save a little money avoiding more crowns. The procedure was quick and relatively easy compared to previous work. When I received the bill from Delta and the dentist I was shocked to discover that none of this scaling was covered as it was coded as odontoplasty - a procedure typically utilized for aesthetic reasons to improve tooth appearance.
When I called Delta there was no wiggle room even though my daughter's procedure was done to remove decay. They hide behind their bureaucratic rules and won't allow the nuances of a situation to affect their decision. It was coded as odontoplasty and that's how it was billed. Zero consideration of individual patients need for the procedure. I feel bad for those who have to work for Delta - what a thankless job. The agent on the phone apologized for the cold, impersonal nature of the process and agreed it makes no sense. But I'm sure the partners will gladly take the profits!
We had Delta Dental coverage for many years through my employer. I retired and got health care coverage through ACA, Covered California. Because of website issues with Covered California we missed dental coverage for our first year on ACA. Since then, we have had Delta Dental coverage. My wife had a non-urgent crown replaced a few months after we again were covered by Delta Dental. They are refusing to cover this crown using fine print in the contract. Be aware of the fine print in their contract. No consideration for long term loyal customers!
Beware of details and unwritten rules for Delta Dental, they lie and cheat and do not care for anyone. Delta told me I had to go to the one dentist they assigned to me and I followed all the rules, even hidden ones, but Delta had assigned me to a dentist that did not accept their insurance. By the time I could get appointment with another dentist, it was July so Delta invoked their unwritten hidden fraudulent rule and told me I was not eligible to the promised "two cleanings in 12 months" because there has to be minimum of 6 months between them. If you keep Delta long enough, you will be in same situation fighting the calendar to get your promised coverage. Customer support will not budge on this and whine at you to not yell at them for their fraudulent criminal cheating behavior. In MANY cases, Delta is more expensive than paying dentist directly.
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Delta Dental Insurance refuses to correct miscoded claim of a partial denture although they are aware that this code is incorrect and the Dentist office admitted on April 3, 2018 that they did not give me the more expensive metal frame partial that was coded. The miscode is to Delta Dental’s advantage because it prevents me from getting any other service to the upper arch.
Bay Ridge Management Corp., Cosmetic & Implant center, ** located at 7708nFourth Ave., Brooklyn NY 11209 sent Delta Dental Insurance claim#** using code D5213 on 9/08/2014. Maxillary partial denture- cast metal framework with resin denture bases (including any conventional clasps, rests and teeth). ** knows that this does not describe my partial. Mine has no metal and seems to be made entirely of nylon or acrylic-vinyl material made for only one side of the arch. My current dentist states the partial ** made for teeth 3,4,5 is a Nesbit. The correct code for the Nesbit provided me by Cosmetic & Implant Center is D1520 (space maintainer- removable – unilateral) only on one side of the arch.
Delta Dental states that they already paid ** of Bay Ridge Management Corporation $750. July 28, 2017 I received a letter from Delta Dental states I had to ask the dentist to correct the code. I requested them to change it to the correct code a year ago. On April 3, 2018, they finally answered my BBB complaint stating that they gave me a more conservative less expensive partial with no metal (The Nesbit).
I was not aware of the problem with the code until on or about June 1 2017, when I received a pretreatment denial Claim ** for my damaged bridge for teeth 12,3,14 on the opposite side of the arch. Which says I am responsible for the entire $2250 instead of %50 or $1125. I have been fighting this decision ever since. I had to pay the entire balance of the $2250 for replacement of the damaged bridge on teeth 12, 13, 14 which was completed Oct 20, 2017. Cosmetic & Implant center, **, D.D.S & Associates or Delta Dental Insurance Company need to correct the code so Delta Dental Ins can approve the claim and reimburse me $1125 paid by me that should have been paid by Delta Dental.
DELTA DENTAL DENTIST HANDBOOK states under Prosthodontics- Removable codes (D5000-D5899) 19: Placement of a removable partial denture and a fixed bridge for the same arch will not be considered for benefit allowance. Use of a code using these numbers is the problem. Its use will cause me not to be able to file a future or current claim on the same arch. I believe this is the reason Delta Dental will not change the code to the correct code of D1520.
After my present dentist sent in claim for my bridge on teeth 12,13,&14, I once again requested Delta Dental to pay that claim. Claim ** for the completed bridge was denied. I received a letter from Delta Dental dated June 1, 2018 telling me they have no jurisdiction over Dr. ** of Bay Ridge Management Corporation because they are a non-member. (Even though they corrected other issues and gone after other money owed by this company when it’s in their favor.) **, who is a member, is the original dentist that was working on this partial. He made such a mass ordering a horrible partial with the metal that would not fit my mouth instead of the Nesbit I had originally asked for.
6/26/18 received tooth implant, as per the Delta PDF bylaws they will pay either the cheaper of two options (bridge, or denture). Well they paid 0, and I'm stuck with $2,774 bill. They further stated in their denial letter "AN IMPLANT PROSTHESIS IS COVERED ONLY IF THE EXISTING PROSTHESIS WAS PLACED AT LEAST 5 YEARS PRIOR TO REPLACEMENT." I lost a tooth from a cracked root that needed replacement, my Dentist and Oral Surgeon can't believe the denied claim. What I also noted on their denial statement they don't include their phone number. I guess they just want are premium and when they deny coverage they don't want to hear back from us. I am intending on pursuing this matter to the attorney general's office as well.
They cover 2 exams, 2 sets of x-rays and 2 cleanings each year. But 1 FM Radiograph every 5 years. I spoke to Kayla at Delta Dental benefits 877-377-5727 complaining about them not paying for my x-rays and that it seemed the full mouth x-rays are never covered on me. Here's what I discovered. The way they've cheated (but she wont use that term) consumers is their internal rule on the cost of x-rays your dentist takes during a routine exam. I recently found out that they bundled a certain amount of x-rays into one full mouth (FM Radiograph). If it's submitted on the same day, and the total payout for them is as much as one FM Radiograph. So your x-ray set that would have been free turns out to be a charge, because you most likely had an event in the past 5 years that they had counted as an FM Radiograph.
And here's a related cheating scheme. If during a year, you've exceeded your plan maximum of $2000, anything above that you'd pay, but would still count against your benefit. For example, that FM Radiograph, and any other services you ended up paying for because the $2000 payout had been reached previously, would still count against your remaining benefits. Thus, you won't be able to get another FM Radiograph paid until 5 years is up starting from the date you most recently paid for it when the maximum was reached.
Word to the wise - call them and ask each time you go to the dentist what you are entitled to in details, and work out any scenario to make sure the dentist won't submit anything that you could lose future benefits on. The average person don't have a clue on this unless they spend much time researching, and Delta Dental laughs all the way to the bank. Any class action lawyer out there? Go after Delta Dental and teach them a lesson.
I pay $20.37 a month for this insurance, and only found out after signing that it is only preventive coverage. My daughter needs her wisdom teeth pulled - and they won't pay anything. If I had known that I would have added her to my insurance. Don't waste your money, get a real insurance.
My dental plan covers 100% of preventative care, and 60% of other dental work, such as a crown. The patient pays 40%, which is a little high, and that's why I didn't think it's a great value, but it's not bad.
Don't waste your money. 3 years ago this was a really good company but now they don't pay hardly nothing. You will pay more on premiums than they cover no matter what happens. I tried to cancel then it was like an act of congress to cancel I called to cancel in Delta Dental in Oklahoma and she said I had to sent an email. They tried to charge me another month but that not happening. Good company gone bad...
I have received dental coverage through my employer. Recently had a bridge done. An estimate was given as usual. This time however they denied my claim because apparently I now have a "poor prognosis" so I get a bill for over 14 hundred dollars. I've already paid over 3 thousand out of pocket. What's the point of having insurance if they don't cover anything. Stay clear of them.
I lived in Florida in 2014 and had Delta Dental through my employer. Our benefits had a $1000.00 for orthodontics. I got Invisalign for my daughter and recently I called her orthodontist who we actually still commute to Florida to finish her service. They said Delta Dental only paid $500.00. I called Delta Dental and was told they only pay $500.00 then the next year they pay the other $500.00. So since I had moved before the second year of service, even though we had the coverage at the time she got the Invisalign, they refuse to pay the other $500.00. It is a total ripoff. None of us employees were told this nor was it in our benefit package.
Do not buy dental insurance with Delta Dental Insurance company. You will be sorry if you do because the insurance is worthless: I bought an individual dental insurance with Delta Dental Insurance. Policy name is Delta Dental PPO Individual. On their website they advertise that the policy I bought will pay 100% for General cleaning twice per year. That what I am looking for. My first cleaning happened on 4/20/18. This cleaning I have done for many years with the same dentist. My past Humana Medicare Advantage Insurance paid the full amount for this cleaning twice per year no problem.
Today 4/30/18 Delta Dental insurance company sent me an email itemizing my cleaning bill. They agree to pay only $28.00 out of a total general cleaning charge of $134.00. They wrote that only one item in the general cleaning bill fall within my insurance coverage and there is a $50 deductible on that item. The rest is my responsibility. I end up responsible for $106.00 of the $134.00 total bill. They never disclose those limits on their website. The only thing they post on the policy that I bought is general cleaning will be covered 100% twice per year. Call them and I was putting on waiting and nobody ever answer the phone. After waiting for 20 minutes I hang up. I feel so embarrassed that I not only wasting my money but also my precious time to deal with this total worthless, dishonest company. It set up only to steal people money. Don't be a victim like I am.
My advice is to stay as far away as you can from this den of thieves. Needing to have some dental work done after several years of neglect, I chose and paid the annual premium for Delta Dental's top of the line program. I was quoted pricing examples for a variety of procedures and thought this coverage best fit my needs. I then visited my dentist for examination and development of a dental health plan. During this visit, I was told the actual prices I would be paying for each procedure. Under Delta Dental's plan, the cost of every procedure was significantly higher than what I had been led to believe when purchasing the plan. My dentist had his own plan, which reduced the cost of my procedures significantly.
Before having any dental work done under Delta's plan, I called to ask them to cancel my policy. I was told policies could not be cancelled after ten days and it was the twelfth day of my policy. I then sent a memo on Delta's website saying I understood there were costs associated with initiating the policy and was will to pay one to two months' premiums to cover this cost if they would refund the remaining policy premiums. I then received a letter from Delta stating my policy length is one year and cannot be canceled. However, at the end of twelve months my policy will be canceled and I will not be eligible to renew after that (As if I would want to). This experience has left me frustrated and angry with Delta Dental, a totally untrustworthy company that illustrates the corporate greed rampant throughout much of our health insurance industry.
Delta Dental consistently sends my reimbursement to the provider even though I am filling out my own claim forms and sending them a receipt to show that I have already paid the provider (which I should not need to do) and I’ve never given authorization for Tricare DD to pay my dental benefits to anyone other than myself. When I call and ask Delta to send my money back to me Delta tells me I have to chase down the money and retrieve it from the person they have sent it to. Even when that provider had no entitlement to the money! If the provider refuses I can access other channels to pursue it. That is wrong! They have removed my right to file and be reimbursed for my own dental benefits.
They are also very difficult to work with. Many providers won’t even deal with them. When I say Delta they say, go somewhere else (When I am paying them out of network cash!). That is why I am forced to file my own insurance. I have to ask them for the Dr’s Id number for claim and they usually won’t provide it. The dental office says, "either we file it or we won’t give you our tax Id for Delta." This is because they have made so many enemies. Delta will find any bogus reason why they won’t process a claim. Most people that I have spoken with at Delta are very limited. I have had Delta Dental Retiree dental program since for 10 years and it's getting worst every year. This company does not see the subscriber as the customer. Delta Dental sees the Federal Government as their customer and as long as the money rolls in they have no further obligation to the subscriber or beneficiary.
How is it possible that customer service has devolved into this? A lovely woman who is a 'representative' cannot comprehend this: "I am calling to find out what it will cost me on my plan for a cleaning, having used up my two free cleanings per year." She could not process the question. "COST. Can you help me?" She couldn't so she put me on hold and finally I had the good sense to hang up. Ten minute on hold and baffled by what must be again - passive aggressive low paid workers who act out by frustrating consumers. OK. Who owns stock in this? Dump!
This insurance is worse than useless! On a recent preventive visit which included periodontal scaling and root planing they paid a total of $80 towards a bill of $1,449. This included only $5.00 towards the exam fee of $127.00 and $75.00 towards the $150.00 fee for a complete series of x-rays. I found out after the fact that periodontal services (scaling and root planing) are not covered. Nowhere in my benefits was this stated. Stay away from Delta Dental at all costs!
Delta Dental is THE WORST!!! Take my word for it, and just go elsewhere. No matter the cost. After carefully selecting a plan, I chose one with a higher premium due to there not being a waiting period. I have gotten a lot of major work done in the past month, and Delta Dental has denied my claims. When I called, they stated that there is a 6-12 month waiting period, and that they are not responsible for what the Healthcare Marketplace did or did not say. Why in the world would there be a 12 month waiting period FOR A POLICY THAT ONLY LASTS 12 MONTHS!!! Now I'm stuck with a high premium, and this ridiculous bill from my dentist. This is complete BS, and a complete rip off. The "American Dream," that people speak so highly of, seems more like a nightmare to me.
When I called the dentist's office and asked if the dentist was a participating Delta Dental provider, I was told yes. I had never had dental insurance, so really didn't know the difference between participating and PPO participating. Here, he was not PPO participating, and did not have to accept the lower payment amount. I called Delta Dental and they told me I should checked first. I ended up owing over $500 more because he was not a PPO dentist. Dentist refused to compromise on the balance. Am now going to another dentist.
I had a crown put in on Feb 5, 2018 and so far Delta Dental has not paid for their part of the crown procedure. I called Vienna Smiles which is where I go see my dentist and they told me that Delta Dental had not paid them their part of the expense for my crown. I left a message for Delta Dental to get back to me about this matter and they told me that the employees of Vienna Smiles never filed the claim. I think that this is very poor customer service.
Recently Johns Hopkins went with Delta Dental. The selection of dentists is very poor. The dentist many employees have used for years will only accept the "premier" plan due to poor reimbursement and is only covered by 80% while this "premier plan" was touted as no deductible, 100% coverage for many procedures it only applies to the doctors on their list who are limited. Hopkins definitely made a poor choice going with Delta Dental.
Delta Dental of Pennsylvania - Hardly anyone takes the not so great coverage so I was having to cover a lot of out of pocket expenses. I’ve been waiting on a check they owe me for months. I was told it was mailed out on Feb 23 2018. It’s now March 7 2018 and still no check. I called and they said I’m not allowed to call back for 15 days. Please avoid these crooks if possible!!!
After waiting months for the policy to take effect, I took my kids to the dentist, who checked to see if we were approved to be seen before the appointment started. One of my children had impacted wisdom teeth and needed surgery. We went to the referred dentist who again checked to see if we were authorized for the removal. I paid our share of over $1200 and my son had the teeth removed. Now I am told that we weren't covered after all and I have to pay the insurance amount of another $1200.
When I called I was told that I signed a form so pretty much pay up or go to collections. At this same time my daughter was being seen for numerous cavities that had been approved. Then I received a bill for all the work that had been done after my co-pay. When I tried to speak to a human at Delta they don't seem to care and recommended that I make a complaint. I did. Where each dental office told me that it could take months before they got actual approval. I received a denial in less than 2 weeks. Of course they took another month payment automatic withdrawal. So to date I have paid in excess of $5,000 for dental work that $3,000 was supposed to be covered. Had anyone simply said you need to wait another month or two to be covered I would of waited. No one seems to care. If you want to avoid the crap we just went through go to another insurance company because Delta only wants your money. They don't care about their clients.
We have had a terrible time dealing with Delta Dental. We have been given incorrect information during multiple calls, and conveniently, no notes were made in their system about the phone calls. We were clearly told that my daughter was covered under my plan, so her individual plan was not necessary. She went to the dentist and we received a bill months later because she did NOT have coverage. They have transferred us to supervisors and not explained the circumstances despite assuring us that they would, so we have had to explain the situation over and over again. They are not willing to help, but admit that the person was wrong about her being covered. They are awful!
I am writing this review as a warning to anyone considering a purchase of Delta Dental Insurance of New Jersey. I purchased a policy on 1/11/18, and decided to cancel it after learning that my dentist would work with me on the price of his services, which turned out to be lower than Delta Dental. I faxed a letter to Delta Dental requesting a cancellation of my policy on 1/30/18. I then received a letter from them explaining that my policy could NOT be cancelled until 1/31/19! So I have to keep paying $60.00 monthly for a policy I WILL NOT USE!
I called customer service on 2/16/18, to dispute this, and was basically told that I am out of luck. I mentioned that I will be eligible for Medicare in May of this year, and then was told that that qualifies as a major life event, and THEN I can cancel the policy! So until then, I am out $240.00? What's up with that? How can they just take your money like that? I was told that they have a time limit of 10 days if someone decides they don't want a purchased policy, so I guess the 18 days I waited was too long to be considered. BUYER BEWARE!
I cancelled my dental insurance with these folks as I had moved to Fla and Humana has a much better deal. I was told that probably could not stop the automatic bank account withdrawal for the coming month but would send me a refund for payment on a cancellation of the account. The rep said I would have a check in three weeks or a credit to my account. That was December 26, 2017. Today, February 13, 2018, I called them to see where the money was and was told it would be 8-10 weeks. I was told the first rep was wrong. This rep was obstinate and arrogant to boot. I talked with bank and they said they have problems with Delta on numerous occasions. I think they believe most people forget. I don’t so will file a fraud complaint against them. Quick to take your funds but not quick to refund when they overcharge a customer. That’s obscene! Be aware when doing business with this outfit.
I got a bill from my dentist for 3 fillings that I believed would be covered, at least in part, by the Delta dental plan had had and not used for the previous 10 months I had it and was paying for it. Nope. Not covered because there was a 1 yr waiting period for anything besides cleanings and exams! Is there any point in paying an entire year for something you can't use? I hate being swindled and Delta is a master at taking your money for nothing.
I am writing an article about Delta Dental insurance. This is what happened to me. I bought a policy through the ACA. I called the company, was referred to a dentist. When I learned I needed dental treatment I called Delta Dental again and asked about the cost of said treatment and got an estimate. Today, after having the work done, I was told that because I am an adult, they don't cover any dental services. I am an adult, I have no children. That is all listed in my plan. I think this is fraud. When I called the ACA people, they agreed. I cannot be the only person to have been through this.
ARRP Delta Dental allows 3 cleanings per year, probably because of the link between. Oral health and heart disease. Permits flexible scheduling, you see a dentist on half of the hygienist appointments. Premium have options.
Delta Dental Plans Association expert review by Cyril Tuohy
Delta Dental, a pure-play dental insurer, is one of the largest dental insurance providers in the country. The company dates back to the 1950s and is committed to expanding access to oral healthcare.
An extensive network: Delta Dental operates in all 50 states.
Plan variety: Nearly every type of dental insurance is offered by Delta Dental, along with unique plans tailored to unique customers. Discount plans are not offered.
Cost-control measures: Delta Dental has negotiated contracts with reputable dentists across the country.
Transparency: Customers can check claims history, estimate costs, review benefits and more on the website.
ACA-compliant: Delta Dental plans are available under the Affordable Care Act on the federal health care exchange.
Affinity: Administers the AARP Dental Insurance Plan.
Best for: Delta Dental is good for families looking for cost-effective dental care and businesses looking to provide coverage for workers.
Delta Dental Company Information
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- Delta Dental Plans Association