ComplaintsforDelta Dental of California Enterprises

Insurance Companies

HeadquartersMulti Location Business

Additional Complaint Information

Customer Complaint:

BBB’s profile for Delta Dental of California Enterprises was created February 1991. A review of complaints was completed in March 2024. For questions related to your dental plan, consumers are encouraged to visit the following link.

https://pgesupport.zendesk.com/hc/en-us

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Initial Complaint
11/05/2024
Complaint Type:
Order Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I retired in 2018 and signed up for **** Delta Dental. I had had Delta Dental with my Surgeons practice. After retiring I had to get my own plan. Now I am being double billed by AARP Delta Dental and ******** Delta Dental. I have been with the **** plan since 2018. The ******** plan went into effect 04/01/2025. I had no idea about the different plans. ******** Delta Dental plan should never have gone into effect. I probably signed up accidentally thinking it was my AARP plan. I called the ******** plan and they will not cancel my plan. I do not need two plans. I have been charged $367 from ******** plan. They basically said tough and will not help me.
Business response
11/06/2024
Good afternoon,

Unfortunately we are unable to assist you with the Delta Dental of ******** plan. Please contact BBB of ********, we are only able to assist with Delta Dental of Pennsylvania, California, and Georgia plans, AARP.

Thank you
Initial Complaint
10/28/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I called Delta Dental during the week of 9/30/2024 and requested to have my Membership ID card be mailed to my address:**************************************** I was told it would take 14 business and I still have NOT received my Dental Membership ID card through my employer: *******************. I have contacted Delta Dental 2 times and they have failed to mail my ID card.I want this request escalated to Executive leadership and I want my ID card mailed out today!!!!!!Insured: **** ***** DOB: ********* Employer: ******************* Group# ****
Business response
10/29/2024
Hello ****,

We are unable to locate your plan. The last policy you had with Delta Dental of Georgia was with group the State of Georgia. Please reach out to the Better Business Bureau in which your plan state is with. We are only able to service members with Delta Dental of ************, ******* and California.

Thank you
Customer response
10/29/2024

Complaint: 22482718

I am rejecting this response because:

I reside in the State of GA and currently I am enrolled in coverage with Delta Dental. My employer is ******* and the Group Number is 7629

Sincerely,

**** *****
Business response
10/30/2024
Hello

Your name and date of birth was searched and the most recent policy came up with State of *******. The policy does not go by the state in which you live but rather the state of your employers headquarters office. Due to not having a policy with Delta Dental of Georgia we are unable to assist you since we cannot view your plan. Please reach out to the number you have been calling to speak with customer service to find out which ******************** enterprise you are with.

Thank you
Customer response
10/31/2024

Complaint: 22482718

I am rejecting this response because:

Sincerely,

**** *****
Initial Complaint
10/24/2024
Complaint Type:
Order Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
In 2022 my daughter ***** received braces under my employer ******'s insurance Delta Dental PPO. In June 2023 I switched companies and my new employer's insurance is Delta Dental HMO. My daughter had a continued care check on her braces with her orthodontist. The new insurance Delta Dental HMO is denying payment to the orthodontist causing responsibility on the orthodontist to ask me directly for payment of $4,380.00. During that time we provided Delta Dental HMO the needed referral information and documents that shows this was a continuation of care from a dental specialist (i.e. orthodontist). They have policy statements on their website stating they will continue coverage for orthodontist work if the proper documentation is provided, which I did along with a health advocate assistant provided by my company Amneal. It is now October 2024 and no resolution of payment has been made on their behalf. There has been multiple touch points with Delta Dental HMO where comments of losing paperwork have happened and staff not resubmitting the claim as they said they would. We tried to escalate to a manager with no response or action on Delta Dental's HMO part. Contacting the BBB seems to be my only next action to help.
Business response
10/25/2024
Good morning

Our records indicate we have received an appeal regarding this under (APP-344378). Please allow up to 30 days for our grievance and appeals team to find a resolution.

Thank you
Initial Complaint
10/24/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I had an infection in my gums that could only be resolved with removing all of my teeth. I went to dentists in the **** and was told it would cost $60,000-$80,000 for permanent implants. I flew to Mexico and spent $12,000 USD on the first surgery. I submitted my claim to Delta Dental and they intentionally cancelled my claim saying their agent failed to attach the proof/documentation I sent to them via email. I waited over a month before finding out Delta Dental cancelled my claim as every time I called, their agents would tell me wait longer for a response. I submitted a second claim via their online portal and the claim was not processed. I called Delta Dental and stayed on the phone for 2 hours to get a supervisor who told me they would help process the claim. Because I went out of network (Mexico) instead of receiving the full $2,500 reimbursement, Delta Dental takes more than half of this money and claims I am only allowed a $1,200 reimbursement after I spent $12,000 USD. I contacted Delta Dental today via their web portal and email and was told I need to submit my claim form for a 4th time. I responded that I am submitting a claim to the BBB and if they continue to withhold my claim reimbursement I will seek legal counsel. I have tried over a dozen times to work with Delta Dental to get my contractual reimbursement and they are intentionally, illegally, denying my claim and drawing out with hopes I will not fight to get my money back. Delta Dental is breaching a legal contract. I hope that the BBB can help facilitate a quick response and resolution from Delta Dental which would be a FULL reimbursement for my claim and any and all additional refunds considering I've provided full documentation and repeatedly contacted Delta Dental while they cancel, block, hide, close, and lie about my documentation and submissions for refund. My Enrollee ID: ********* and Group number: ***********. Please contact the business and inform them of their legal obligations.
Business response
10/25/2024
Good morning

I do see on 8/13/24 there was a submission of your claim and documents to route over and be processed, I am not sure how they were sent in but when I clicked on the documents I could not view them which could be why it was never processed. I do apologize that is no excuse and while I cannot explain the actions of the customer service department I can assure you grievance and appeals have received the documents you have attached today and sent them over to be processed. We understand your frustration and are sure you no longer want to wait for this but please allow processing time to receive an update. You are more than welcome to call in and check on this here is the reference number SF20241025552811988.

Thank you
Customer response
10/25/2024

Complaint: 22470092

I am rejecting this response because: I am not sure why I am receiving an Accept or Reject for BBB reaching out to Delta Dental. I have been trying for 5 months to get this issue resolved and Delta Dental has continued to take steps to prevent paying my contract refund for surgery I had in June and the multiple times I have submitted documentation. I selected reject, because I dont want this case to close without help from the BBB to try to resolve this issue. If we cannot resolve this issue, my only remaining option would getting legal counsel. Please help coordinate efforts with the business as Delta Dental is legally bound by contract to provide the refund they have been refusing to provide me.

Sincerely,

***** *******
Business response
10/28/2024
Hello

A response was given for assistance. As stated there was a reference number given to check the status of the claim. I understand your frustruation with the contact center and what they promised you however I have given you a reference number to check this and assure you everything you've attached has been sent over to be reviewed.

Thank you

Customer response
10/30/2024

Complaint: 22470092

I am rejecting this response because: I am still waiting on the business to properly file my insurance claim that I have been waiting for since June. In every attempt to process my claim, the business has made continuous excuses including cancelling my claim without providing me notice or reason. The business has not process my claim and stating I need to keep calling them for months to try to get updates on my claims has me over 20 hours of my personal time wasted trying to process this claim. I have lost more money trying to process this claim, then this claim will provide as a refund. I had to leave the country for anything near "affordable" health care. I went to a doctor here in the **** for a follow up for xrays and exam. The office took xrays then the dentist came in pulled open my mouth, hurting me when I had fresh stitches, then the doctor said, "it looks fine. there's nothing i can do for you." I have been paying into this insurance for over a decade and when it truly matters, when I really need help, this is how I am being treated.

Sincerely,

***** *******
Initial Complaint
10/22/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
for the past several weeks, my spouse and i have been trying to call this non-responsive dental insurance business to provide clear and concise dental work done on me and alongside respective charges, in particular for implant work being done on me which is rejected now!!when contacting DELTA DENTAL, a considerable amount of our time is wasted on the phone trying to come up with correct spelling of my name; f like *****, a like *** an so on. in short they always get it wrong. i have called them 4 time thus far without a clear communication with any of the staff.i simply want to finish my dental work ASAP and never talk to this business entity again, for real!
Business response
10/23/2024
Good morning

Please explain what the issue is regarding your treatment.

Thank you
Customer response
10/23/2024

Complaint: 22461493

I am rejecting this response because:
there was no sensible reply

Sincerely,

***** **********
Business response
10/24/2024
Hello

The reply is a question. Your complaint is not clear. Please advise are you disputing a claim or the fact that you are not getting the answers you need from the call center? The more detailed you are the better it is to try to assist you.

Thank you
Customer response
10/24/2024

Complaint: 22461493

I am rejecting this response because:
The consumer has been unable to obtain authorization for continuation and completion of dental implant work to be done.
(Please explain why the claim has been denied. by BBB employee DG)

Sincerely,

***** **********
Customer response
11/08/2024
Thank you for the clarification. Our records indicate the implants were paid for this member at 50%. If he could provide a claim number or date of service as to what claim he sees denied that would be great but on our side I show services were paid at 50%.
Initial Complaint
10/15/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I went online on 9/25 to see my claim was denied for no proof of payment. Which they already had. They dont even email you for notifications first off. So I called on 9/25 and the lady who answered said the same thing To send in a screenshot. I said I did, and she said oh I see it, But it was never sent back in for reprocessing I said it should have been reprocessing so she says she did it that day. I emailed on 10/2 to get status and she says she has been away and will process today. So I wait u til today to check in again 10/14 and she says it was never sent in for reprocessing. And that it will take up to four weeks again. It feels like Im just getting the run around now. I called 3 weeks ago when it was initially declined trying to get this handled, And now my time is reset again. She said I can file a grievance and swiftly said can I help you with anything else. This is really frustrating. I dont know what else I can do. I waited patiently and just wanted an update 3 weeks later. I will be filing a complaint with the ca and fed **** of healthcare.
Business response
10/15/2024
Hello

The x-ray that was submitted in September they were not able to open it , I see you spoke with an agent yesterday and they only have the claim and xrays attached to the notes, could you please send the receipt here so we can see if this will open and get this processed for you

Thank you
Customer response
10/15/2024

Complaint: 22422802

I am rejecting this response because:
the x-ray were sent in by mail. So delta dental put it into your system. Not me.

Sincerely,

***** *********
Business response
10/16/2024
Hello

Can you send the xray through this portal please so that we can process the claim ?

Thank You
Initial Complaint
10/07/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Delta Dental of California is my employer-provided dental coverage. I submitted a claim four months ago. Delta Dental simply does not process the claim. I have called and spoken to their support team repeatedly, which means wasted time navigating an obstructive phone tree and being transferred repeatedly. Each time I am told that the claim is in the system, but awaiting some action internally. Nothing is needed from me or the provider, but the claim never progresses. I already paid the provider. I'm waiting for my payment! Since my only access to my benefit is through Delta Dental and my only access to Delta Dental is via phone representatives with no news or power, I have essentially given up on seeing my payment. But if Delta Dental is going to cheat me, essentially fraudulently claiming to provide dental insurance and instead providing unfulfilled promises, then I'm going to log this with BBB in the hopes that someone can read this and avoid being cheated.
Business response
10/08/2024
Good afternoon,

We have no record of receiving the information on file, however I have attached the documents you have submitted and sent them for processing. Please allow time for our claims department to review this information.

Thank you
Customer response
10/09/2024

Complaint: 22390364

I am rejecting this response because: On two separate occasions I have spoken with representatives who assured me that the claim was already in the system and needed nothing further from me. I sent the claim to the business in June and again in July. After two months of waiting I called in late September, was told that the claim was in the system, but not processed and advised to call back in two weeks. I did so, with the same result. For the company to say that they have no record of the claim at this point is either criminal deceit or incompetence.

Sincerely,

Russell Thomas
Business response
10/10/2024
Hello

I apologize of your earlier conversations but as stated in my previous email there was no claim processed. However I have taken everything you attached and sent it over for processing I can assure you while I cannot attest to what customer service has provided to you previously, this is the grievance and appeals team and we take your concerns seriously. Please allow time for the claims team to review the attachments.

Thank you
Initial Complaint
10/03/2024
Complaint Type:
Service or Repair Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
1- My dentist **** **** ******* ************) during the last six months has mailed 3 times a mail about my teeth evaluation which needs to be done to my Delta dental insurance, his last mail was on August 2024 and it was certified mail to the address provided to him by the insurance agent. 2- After several months and several phone contacts, my dental insurance still has not responded. 3- The job that needs to be done on my teeth is very costly. 4- If Delta Insurance does not respond to Dr. ********* mail and his evaluation, my coverage will end on December 5- My teeth work won't be done as I am paying so much as a premium to my insurance. 6- I am holding Delta Dental Insurance responsible for paying the cost of my teeth, I won't purchase this insurance in the future and I am expecting Delta to pay the cost even if it takes many months for them to respond to my dentist evaluation. next year
Business response
10/07/2024
Good morning

Please explain what needs responded to ? Is this a claim please provide a date of service?

Thank you
Customer response
10/07/2024

Complaint: 22373731

I am rejecting this response because:
I explained over the phone to Delta dental manger and two more times to Delta representatives, also My dentist ( ** ******* ****) was on the phone at the same time,
Dr. ******* evaluated my teeth, he has mails you 3 times during the last 6 months , his last mail was certified, he is waiting delta to respond to his evaluations, if you have more questions call his office,
I will not renew my insurance with delta next but delta is responsible for the cost of what *** **** ******* needs to do on my teeth to fix it.

Sincerely,

***** **********
Business response
10/10/2024
Hello.

Please advise what is being sent to Delta Dental that needs to evaluate, if this is a claim please advise the service date. The complaint needs to be explained in detail in order to assist you.

Thank you
Customer response
10/11/2024

Complaint: 22373731

I am rejecting this response because:
My dentist Dr. **** ******* has mailed you 3 times during the last six months after his evaluation of my teeth , ( He wants to know how Delta will cover the cost of my teeth issues so he can start fixing it.) the last mail was certified also mailed t by his office to the address which got while all 3 of us were on the phone the Delta dental staff advised him to mailed it to that address.
As I told to Delta manager by phone : If you have any more question ask DR ****** office.
I can not believe Delta throng the dentist evaluation to trash and not responding at all also has no clue about dentist communication and patient teeth problems? also keep asking the pt. about the detail of pt. evaluation
Any question ask my dentist, Delta has to be paid full cost of my teeth issued to be fix, even after end of this year which I will never buy delta insurance again..
Sincerely,

***** **********
Initial Complaint
09/30/2024
Complaint Type:
Product Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
I had a policy for Delta Dental when I lived in California. I left California in May 2024 but on July 18, 2024, Delta Dental sent a check for $498.20 to my old California address that is meant to reimburse my dentist for services rendered prior to me leaving California. After learning about this I contacted Delta Dental, provided a current address and was told it will take about fifteen business days for me to receive the check. Its been almost a month later and the check has not been mailed. I called today for an update and was told since I did not call back within two weeks they could have helped. Now, Im at risk of this account going to collections because Delta Dental is now telling me it will be another 15 days before I can get the check. I spoke to ******, and the supervisor was ******* ******, who refused to get on the phone.
Initial Complaint
09/30/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
On 5/20/24 went to dentist found out I need gum surgery; on 6/11/2024 Dental Dental denied service said I need x rays; on 7/22/24 had the x ray completed; on 8/13/2024 dentist resubmitted request for approval of surgery; 8/19/2024 delta dental scanned info into computer but dropped the ball and did not submit information for approval; Because I did not receive approval I contacted Delta Dental and was told we have all the information and we have up to 6 weeks before we have to inform you of our decision. I waited until the 6 week period and called back again on 9/25/2024 again there are no answers I asked to have a supervisor call me back INQ ****** they have 24 - 48 hours to call me back. No call back, I called again today 9/30/2024 again asked for a supervisor ******* G #SF2024093054949682 spoke with me and said someone from Delta Dental dropped the ball. I had to change my surgery date from 10/1 2024 to 10/22/2024. I asked ******* if she could expedite the decision as I have been since May. ******* said she could not expedite, I asked to speak with her supervisor she said she has no supervisor all I could do was to go to their website and put in a formal complaint. I do not believe no one could do anything in this place of business. They have continued to lie to me over and over again to just get me off the phone.
Business response
10/04/2024
Good morning

This was approved on 9/30/24 please allow 7-10 business days to receive your statement

Thank you
Customer response
10/04/2024
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. Thank you for your help.

Sincerely,

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

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ComplaintsforDelta Dental of California Enterprises

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