ComplaintsforDelta Dental of Kentucky

• Initial Complaint

  09/16/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I have moved out of coverage area, and had a change of income status. Both reasons that i should be able to cancel my coverage according to my site, but they won't let me because they changed their systems and said they can't help me for a month.

  

  Business response

  09/20/2024

   
  Dear *** *********
  
  Delta Dental of Kentucky, Inc. (“DDKY”) is currently migrating to a new processing system which will allow us to provide our members with enhanced information technology solutions and processes.  During this brief migration period, day to day operations are held in a pending mode; this allows for the smooth transition of records and information from the old system to the new one.  Members who are impacted by this unavoidable business interruption will be reimbursed and/or refunded accordingly. If a member has a unique situation in which the business interruption poses an undue hardship for them, this member’s extenuating circumstance will be addressed on a case by case basis.  When warranted, DDKY may, in its sole judgment, provide such members with additional consideration for the inconvenience associated with the migration period and take a one-time action to rectify the member’s impacted experience.   
  The above referenced complaint indicates that the complainant (member) understood the reason for the delay and was unsatisfied with our response.  Accordingly, DDKY will cancel the member’s account and refund the complainant via a check with no additional consideration owed to the complainant. 
  
  If I can be of further assistance, please let me know. 
  
  
  Sincerely,
  
  /s/
  
  ******** ** ******* ******* ******* * ********* **********************************
  
  

• Initial Complaint

  06/14/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  They will not give me an estimated cost of dental services such as the allowed amount. My provider had sent in a pre-treatment form. I just want to know how much it is going to be for my out of pocket expenses. They have to know the amount.

  

  Business response

  06/15/2023

  Good afternoon,

  As passed by the Kentucky legislature, HB 370 doesn’t allow for the application of a member’s certificate of coverage (which is unique to each group) and the Delta Dental processing policies.  Together, the certificate of coverage and the processing policies assist DDKY in adjudicated claims for our members.  Medical and dental procedures rarely go exactly as planned and because health care professionals cannot know with certainty what final combination of services will be completed, DDKY is not able to accurately apply the appropriate processing policies and coverage parameters to estimated services that may or may not be completed.  As a result, DDKY may not be able to provide a PTE for some dental services.  In those instance, DDKY encourages our members to visit our website and use the dental cost estimator tool, which will provide the member with a out of pocket expense estimate associated with the proposed treatment plan.  DDKY understands and apologizes for any inconvenience this may cause our members.  
  

  Customer response

  06/21/2023

   
  Complaint: ********
  
  I am rejecting this response because: It still does not provide me with the information I need to make an informed decision regarding my health.  Delta Dental has the information I need because it all goes back to billing codes.  Regarding things in your response:  I am asking if the procedure goes as planned what would be the price they would pay.  I understand things do not go as planned sometimes, but if they did what is the cost.  I am NOT asking for the cost if something goes wrong and another procedure has to be completed.  HB370 was supposed to make things more transparent for the consumer.  HB 370 says if the provider requests by using a format prescibed by the dental carrier a prior authorization should be issued.  This prior authorization should include "Indicates that a specific procedure is, or multiple procedures are, covered under the covered person's dental benefit plan and reimbursable at a specific amount, subject to applicable cost sharing".  I am again requesting what is reimbursable at a specific amount.

  Sincerely,
  
  ******* ****

  

  Business response

  06/30/2023

  Good afternoon,

  HB 370 requires Delta Dental of Kentucky, Inc. ("DDKY") to be held to pre-treatment estimate ("PTE") as the final source to adjudicate a claim.  Since healthcare professionals cannot know with certainty what final combination of services will be provided to a member prior to completing those services, there is a high likelihood that members will pay more out of pocket for services that may be covered by their plan. To help put this into context, pre HB 370, DDKY would have been able to re-adjudicate a PTE, allowing a member to receive plan benefits for services actually completed by the provider.  Post HB 370, the PTE would be the final authority for services rendered to the member, and any additional services completed by the provider would be owed entirely by the member, even if the member's plan provided benefits for those completed services.  This inability to re-adjudicate a PTE has the distinct likelihood of increasing a member's out of pocket expenses at the time services are performed by the provider.  Without the ability to re-adjudicate a PTE when dental procedures change, DDKY cannot state affirmatively that our members are receiving their full benefits or are being billed appropriately by their provider.   DDKY strives to ensure that our members receive the full value of their dental benefits.  

  Customer response

  07/10/2023

   
  Complaint: ********
  
  I am rejecting this response because:  It still does not answer the questions I posed.  You have to know an allowable amount.  Provide me with this information instead of being a barrier to care.  HB370 does not prohibit you from doing this.  Again, I am asking for an allowable amount based upon this particular procedure NOT IF other procedures need to be completed.  Just be ethical, as if it were you, you would want to know how much money it is going to be out of your pocket.  You go to the grocery, the bag of chips says $3.99 you know you are going to pay $3.99.
  
  Sincerely,
  
  ******* ****

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