ComplaintsforFidelio Insurance Company

• Initial Complaint

  01/23/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Fidelio dental is the provider for our families dental insurance. There have been countless issues concerning coverage, in-network, and out-of-network providers, and reimbursement. Unfortunately, we have been to Aspen Dental in the past and been charged an astronomical amount (because they balance bill despite participating), and had a horrible experience there. This is the ONLY participating provider within 200 miles of us. We have requested on multiple occasions for them to authorize us to see out-of-network providers while covering at the in-network reimbursement considering the circumstances. Our plan currently consists of 80% coverage of the *** for in-network and only 50% of the *** for out-of-network. That 30% makes a big difference when you have a family of 6 and have already incurred over $2,000 in dental bills within the last 9 months. My husband and I are very understanding people and try to give the benefit of the doubt, but this has been a constant frustration that regardless of our countless phone calls, nobody has been able to help us. The members of their union who live around Philadelphia have much more access to participating providers; however, that is a 4 hour drive from where we live. My husband was recently diagnosed with severe periodontal disease and is at risk of losing his teeth if treatment is not started with a periodontist immediately. I had swelling of my entire left side of my face for months because I didn't want to have to pay the ridiculous amount to see an oral surgeon and have their testing. They should have all the phone calls on file that I have made regarding this issue for myself because the oral surgeon was said to participate (which I verified with fidelio multiple times), yet they only paid the out-of-network fees.

  Business response

  03/09/2023

  Relative to ****** **** needing a Periodontist, he may go to any of the in-network periodontists listed above. If *** **** elects for whatever reason not to go to a Fidelio in-network provider, Fidelio will extend him a one-time courtesy of adjudicating any out-of-network claims from a periodontist using the 80% In-Network percentage and In-Network Fidelio fee schedules. However, *** **** would be subject to balance billing. Fidelio will process and pay benefits for claims up to the Dental Plan's maximum annual individual benefit of $1,500. If *** ****'s out- of-Network Periodontal claims exceed his annual maximum, he would be subject to pay the full provider charge. 
  Sincerely. 
  ********** **** 
  Director of Operations 
  
  

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