ComplaintsforNCD

• Initial Complaint

  06/10/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  NCD is a dental insurance I pay monthly. My dentist submitted a claim for work on 12/29/23. I have multiple times spoke with the insurance that insisted that my dentist did not submit the claim. The dentist office spoke with the insurance directly several times and the insurance had multiple reasons why the claim is rejected. All was fixed. We had a conference call three ways. I understood that all is ok and I will get a check within two weeks. Calling today again I was told no claim was submitted, then,name spelled wrongI have a copy of the claim and all is correct. I already paid the dentist and I am delaying care because I am not sure I can afford to continue. Thats why I have insurance. All the agents we speak to in the claim department say the same thing, they dont look at the correspondence prior. I feel they are just stalling from not paying what is am owed. Three weeks ago a supervisor named ****** and the dentist office and I has a three way call. ****** said all is well. I am frustrated. Very poor business. I have records of every call with them. Names and dates.

  Business response

  07/11/2024

  The member is enrolled in a dental plan offered by NCD, which is a leading dental and vision program providing best-in-class dental and vision insurance products underwritten by A+rated insurance companies.  NCD provides enrollment services for independent agents, and billing and customer service for insurance companies that we work with.  NCD is not an insurance company and does not manage claims administration or processing and payment of claims.
  
  The complaint is regarding a claim for the dependent spouse of the primary member for a date of service on December 29, 2023. Their dental coverage was effective February 1, 2021.
  
  The dental plan has a plan year maximum benefit of $5,000. There is a $50 deductible for basic and major services. The plan provides benefits for covered ************ services at 100% of the allowed or network contracted rates, benefits for covered ***** services are paid at 80% of the allowed or network contracted rates, and benefits for covered ***** services are paid at 50% of the allowed or network contracted rates. There is no waiting period for ************ and ***** services. There is a 12-month waiting period for ***** services.  The NCD dental plan is a PPO dental plan which provides both in-network and out of network benefits.  The plan does have benefits for implants under major services.  There is a Missing Tooth Clause that applies to implants and is found in the Dental Implant Rider: Implants and Implant supported prosthesis covered under this plan are limited to; 1) the replacement of permanent teeth extracted while insured under this plan.
  
  Upon receiving the complaint, NCD contacted the claims payor, MBA, to try and obtain information regarding the dependents claim for dental work done on December 29, 2023. MBA advised the NCD representative that the claim was denied due to the policy holder name on the claim form not matching the policy holder information in their system.  MBA pulled the original claim form that the provider submitted, and the provider entered the dependent as both the primary policy holder and the patient.  This is why the claim was denied.  The NCD representative contacted the provider and explained to them why the claim was denied and asked them to resubmit the claim with the correct policy holder information and then show the dependent as the patient.
  
  The dental claim was resubmitted by the dental provider and has been processed by MBA. The claim included charges for 2 dental implants billed at $1,989.00 each. The network repricing came to $1,795.98 for each implant.  ************* benefit for one implant was paid at 50% of the network price less the $50 deductible for a payout of $872.99. The member is responsible for $922.99. There was no benefit payable for the 2nd implant as it was subject to the Missing Tooth Clause due to the tooth being extracted prior to the coverage effective date of the NCD dental plan. The member is responsible for the network repriced amount of $1,795.98.
  
  An NCD manager reached out to the dependent spouse to advise her of the information that was received from MBA.  Unfortunately, the spouse stated that she did not have time to talk at that time and would call the manager back.
  
  Per the terms of the Complaint and Appeal Procedures included in the Dental Certificate of Coverage, the member can file a written appeal to MBA.  The following is the information on how to file the appeal.
  What if You dont agree with a Claim denial?
  If We send You a written statement denying Your Claim in whole or in part, You may submit a written appeal to Us that outlines Your concerns and Your efforts to resolve the matter. The appeal must be filed within 60 days of the receipt of denial. A written decision with respect to the appeal shall be sent to You within 60 days after its receipt, unless special circumstances exist which require additional time, in which case a written decision with respect to the appeal will be sent to You as soon as possible.
  Please send to:
  MBA, Inc.
  Attention: MFD Appeals
  ***********************************************************************************

• Initial Complaint

  05/30/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Member ID ********* My name is ************************* and I am writing this complaint on behalf of my uncle *****************************, who has the dental coverage. His member ID is stated above.****************** has had NCD dental coverage since Jul 2019 or 2020 and has not needed to use it until the last year. The coverage is a secondary insurance for him, which means all his preventative care is covered by his primary insurance. Within the last year, ****************** has needed major services, that his primary insurance does not cover. So, he has been presenting his NCD dental coverage to different dental offices and they are not accepting the insurance. They are saying they do not recognize it. He's been to 7 -10 dental offices. He has called NCD 6 -8 times, complaining about the issue. They provided him with a list of dental offices 3 or 4 times. He would make contact but the dental office would still not accept the insurance. He made a final call, prior to doing a group call with myself and NCD scheduled him an appointment at Aspen Dental. He went to the appointment and they said, he's in network but not in network. However, they would still not provide any services.We made one last call to NCD and requested to cancel the insurance and asked for a full refund due to not being able to get any services from the insurance plan. Within that call, we were told that at most, they would refund two months becuase you have 60 days to cancel. I informed the representative that it was not fair due to major services not being available until one year after being on the plan. How are u to know that dental offices will not accept the insurance if u can't use it till after a year but if you don't need it for years later, how is a refund of two months fair.We last spoke with NCD on 10 May and was informed that they would call back to see if the exception to policy had been approved for a full refund. Its now 30 May and we have received no call back. ****************** is looking for a full refund on plan.

  Business response

  06/17/2024

  NCD is a leading dental and vision program providing best-in-class dental and vision insurance products underwritten by A+ rated insurance companies.  NCD provides enrollment *******s for independent agents, and billing and customer ******* for insurance companies that we work with.   NCD is not an insurance company and does not manage claims administration or process and pay claims.
  
  An independent agent enrolled the member in a dental which is *******d by NCD.  The enrollment was electronically submitted to NCD on May 28, 2020, for a coverage effective date of **** 1, 2020.
  
  The dental plan is a *** dental plan which provides both in-network and out of network coverage.  Members will pay less out of pocket if they utilize an in-network provider. The dental plan includes benefits for 3 classes of *******.  Benefits for covered ********** Services are paid at 100% of the *** network contracted rate, and benefits for covered ***** Services are paid at 80% of the *** network contracted rate. There is no waiting period for ********** or ***** Services.  Benefits for covered ***** Services are paid at 50% of the *** network contracted rate. There is a 12-month waiting period before the plan will pay the 50% benefit for ***** Services. The 12-month waiting period for ***** Services can be waived if the member has proof of 12 months of continuous prior *** dental coverage.
  
  The member spoke to NCD members *******s several times over the years.
  
  On June 30, 2022, the member called NCD member *******s stating he called his provider and they told him they were not an in-network provider for his dental plan.  The NCD representative was able to verify that the provider is in-network and advised the member to ask the provider to contact NCD to verify his eligibility.   NCD was able to verify with the dental claims payor that a claim was paid for the member for a date of ******* of **** 1, 2022. The member had a dental exam and full mouth x-rays.  The dental exam was covered at 100% and the full mouth x-rays were paid at 80% and after the $50 annual deductible the member paid $56.81 to the dental provider. The niece mentioned in the BBB complaint that her uncle had another dental plan as his primary dental insurance that paid for all his preventive care.  However, when the dental provider filed the claim, they did not advise the claims payor that he had other dental insurance, so his claim was paid as if the NCD dental plan was his primary insurance.
  
  The member and his spouse called NCD member *******s on August 30, 2022, and stated that their dentist did not recognize NCD for their dental plan.  The member ******* representative explained to them that NCD is not the insurance company or *** network and advised them the correct information to give to the provider. The representative looked up the provider and advised them that the provider was in-network.  NCD was able to verify with the dental claims payor that a claim was paid for the member for a date of ******* of ********* 1, 2022. The member had a dental exam, cleaning, bitewing x-rays, and full mouth x-rays. The exam, cleaning and bitewing x-rays were paid at 100%. Since the plan only pays for one full mouth x-ray per year and the member just had full mouth x-rays done on **** 1, 2022, the member was responsible to pay the provider $59.44.
  
  The member spoke with NCD member *******s, on April 4, 2024, and April 30, 2024,regarding an in-network dental provider. The member stated that the provider contacted him and advised him they are not in-network.  The NCD representative was able to verify that the provider is in-network and contacted the provider and confirmed they are in-network.   On April 30, 2024, the member called stating his provider is again saying they are not in-network and that he needs to see a provides as quickly as possible for a broken tooth. The NCD representative advised the member that if he was having issues with that provider they would try and locate another provider in his area. The representative made several phone calls and found a provider that was in-network that could get the member in the next day.
  
  The member and his niece spoke with an NCD member ******* supervisor on May 10,2024.  They stated that they were still having issued trying to find an in-network provider.  The supervisor apologized for the confusion and stated he saw notes in the member account that an ****************** representative had called and spoken directly with providers that confirmed they were in network. The supervisor offered to call the dental providers again to confirm they are in-network.The niece refused and stated that they just want to cancel and receive a full refund.  The supervisor advised her that he was not able to authorize a refund back to **** 1, 2022. The niece stated she would file a BBB complaint.
  
  When NCD received the BBB complaint, an NCD manager called the member to try and resolve the complaint. The manager was not able to leave a voice mail as the mailbox had not been set up.   The manager then called the niece that wrote the BBB complaint and she answered.  The niece tried to conference the member in but he did not answer.  The NCD manager addressed the request for a refund. She advised the niece that although she stated in her complaint that her uncle never used the dental plan, there were in fact two claims filed and paid in **** 2022 and ********* 2022.  The ***** stated that her uncle told her he never used the dental plan.  The ***** advised the manager that she would speak to her uncle.
  
  The niece called the NCD manager back the same day and stated she had spoken with her uncle and he did admit that he had used the dental plan.  The niece apologized for wasting everyones time and asked for the contact information at the BBB so that they could retract the complaint.
  
  The NCD manager tried again to call and speak to the member to make sure he understood why he would not receive a refund. She was not able to speak to the member and was not able to leave a voice mail.  The NCD manager sent the member an email advising him that she did speak to his niece. The manager also attached copies of the EOBs for the claims that were paid and advised the member if he needed any assistance with any other claims that had not yet been filed, to please contact her and she will assist him.  As of today, June 17, 2024, NCD has not heard back from the member.

• Initial Complaint

  03/24/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I am submitting this problem with customer service with ****************** Nationwide Dental. Claims for dentures has been mailed 3 times, emailed 4 times, and faxed 4 times. After many phone calls, NCD says that the mailed information was sent to the wrong address. A different address was provided from NCD and mail was sent to that address, but was told it was never received. The emails would not go through. ***** had confirmation of delivered but was told they do not accept faxes, faxes were sent to the number listed on the insurance card. When following up after the first fax, we were given another number to send faxes to. Speaking to different employees each interaction, we were told that it was too late to send any claim then calling back the voicemail stated, " they was no longer taking phone calls". Then called another time and they said they never received any faxes, but while on the phone the fax was coming through on their end hours after it being faxed and receipt of receiving the fax happened hours prior. During this phone call, I was told half of the claim would be paid but not sure where this stands. This company did not seem to care about helping someone who has signed up for their insurance.

  Business response

  04/10/2024

  NCD is a leading dental and vision program providing best-in-class dental and vision insurance products underwritten by A+ rated insurance companies.  NCD provides enrollment services for independent agents, and billing and customer service for insurance companies that we work with.   NCD is not an insurance company and does not manage claims administration or processing and payment of claims.

  An independent agent enrolled the member in dental and vision plans which are serviced by NCD.  The enrollment was electronically submitted to NCD on March 31, 2021, for a coverage effective date of April 1,2021.

  A Welcome Letter was emailed to the member on April 1, 2021.  The welcome email provides information as to when the member should receive their ID card and plan information in the mail, information regarding the dental plan PPO networks, contact information for NCD member services, as well as a link to the NCD member portal. The member portal gives the member 24/7 access to review the dental plan summary of benefits, download a copy of the certificate of coverage from the insurance company, ability to download temporary ID cards,and includes a link to locate in-network dental providers. 
  
  The dental plan has a plan year maximum benefit of $5,000. The plan provides benefits for covered ************ services at 100% of the allowed or network contracted rates, benefits for covered ***** services are paid at 80% of the allowed or network contracted rates, and benefits for covered ***** services are paid at 50% of the allowed or network contracted rates. There is no waiting period for ************ and ***** services. There is a 12-month waiting period for ***** services.  The NCD dental plan is a PPO dental plan which provides both in-network and out of network benefits. The plan pays benefit amounts based on the allowed or network contracted rates.  If a member chooses to use a dental provider that is out of network, the member will have to pay the difference between the dental providers billed rates and the allowed or network contracted rates.
  
  The member contacted NCD member services on January 31, 2024, stating that she needed assistance with claims for services done in April of 2022 and January of 2023.  The member states that the dental provider she used was an out-of-network provider and they did not want to assist her in filling out the claims forms or filing the claim.  The NCD representative advised the member that she would need to transfer her to ***, which is the claims payor, and they could assist her. The representative transferred the member and stayed on the line to advise the *** representative that the member needed to file a claim.The *** representative stated they would email an *** claim form and if the member needed assistance completing the form she could contact ***.
  
  The member contacted NCD member services on March 8, 2024, requesting an update on the claim that she had submitted to ***.  The member stated that she has sent the claim form to *** but has not received a response from them regarding the claim.  The NCD representative provided the member with an email address for *** to escalate the status of the claim.
  
  Since receiving the member complaint from the BBB, NCD has contacted *** to find out the status of the claim. *** advised they now have the claim for the April 4, 2022, date of service.  *** further advised that the terms and conditions in the certificate of coverage for the dental plan require that claims be filed and received by *** within one year of the date of service.  Since the completed claim was received by *** well past one year after the date of service, the claim was denied.
  
  The Claim Provision section in the certificate of coverage states the following:
  When to submit a claim: Proof of Loss must be provided within 90 days from the date of loss to file written Proof of Loss. We will not deny or reduce any Claim filed after 90 days from the date of loss if:
  1.it was not reasonably possible to file the Claim within that 90-day period.
  2. the Claim is filed as soon as it is reasonably possible. In any event, Proof of Loss must be given to Us within 1 year after it is due, unless You are legally incapable of doing so.

  Although the claim was received by NCD well after the one year stipulation, NCD has requested *** to reconsider the claim denial.   *** advised us that they will escalate NCDs request and will investigate further the reason the member did not submit the claim within the one year stipulation.  The member can contact *** directly using the contact information that she currently has for *** to check on the status of the claim.
  
  Also, per the terms of the Complaint and Appeal Procedures included in the certificate of coverage, the member can file a written appeal to ***.  The following is the information on how to file the appeal.
  What if You dont agree with a Claim denial?
  If We send You a written statement denying Your Claim in whole or in part, You may submit a written appeal to Us that outlines Your concerns and Your efforts to resolve the matter. The appeal must be filed within 60 days of the receipt of denial. A written decision with respect to the appeal shall be sent to You within 60 days after its receipt, unless special circumstances exist which require additional time, in which case a written decision with respect to the appeal will be sent to You as soon as possible.
  Please send to:
  ***, Inc.
  Attention: MFD Appeals
  ******************************************************************************************
  
  The member can contact NCD member services if they need assistance in trying to contact ***.

• Initial Complaint

  03/04/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  This company has been changing my checking account for 12 months. I never signed up for this service, I am 75 years old and they never answer the phone or call me back. They refuse to help me cancel their service or assist me with finding out why they are charging me. I will have to close my checking account to get them to stop charging me and my VA benefit and SS both go into that account. This company is a fraud the scams old people.

  Business response

  03/08/2024

  NCD is a leading dental and vision program providing best-in-class dental and vision insurance products underwritten by A+ rated insurance companies.  NCD provides enrollment services for independent agents, and billing and customer service for insurance companies that we work with.

  An independent agent enrolled the member in a dental plan which is serviced by NCD.  The enrollment was submitted electronically to NCD.

  Prior to the complaint, the last interaction that NCD had with the member was on August 19,2021.  The member called NCD member services requesting ID cards and plan information be mailed to him.

  Upon receiving this complaint, an NCD representative called the phone number that was provided in the complaint to get more information from the member. The phone number was for the members son.  The NCD representative was able to speak to both the member and the son. The son advised the representative that his father has cognitive/memory issues. The member and son stated that he may have enrolled in the dental plan but does not remember doing so.  The NCD representative assured both the member and his son that NCD has a high standard for customer service and that she would get this resolved for them and apologized for the negative experience theyve had.

  After verifying that there were no claims filed for the member, the NCD representative escalated the complaint and advised NCD management of the conversation she had with the member and his son. The NCD management team attempts to look at each individual situation with understanding and empathy and agreed that under the circumstances a full refund would be issued to the member.  A refund check was processed today, March 8, 2024,and will be mailed the same day.  The NCD representative contacted the member and son to advise them the dental plan has been cancelled and a full refund has been issued via check and mailed to the member.

  Please let us know if there is any additional information that either you or the member may need from NCD.

• Initial Complaint

  10/29/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Policy sold too me was a lie. No body in my area is in network. Also didn't tell me ncd is not and insurance company. Haven't used this policy yet.

  Business response

  11/09/2023

  NCD is a leading dental and vision program providing best-in-class dental and vision insurance products underwritten by A+ rated insurance companies.  NCD provides enrollment services for independent agents, and billing and customer service for insurance companies that we work with.   NCD is not an insurance company and does not handle claims administration or processing and payment of claims.

  An independent agent enrolled the member in a dental plan which is serviced by NCD.  The enrollment was electronically submitted to NCD on September 27, 2022, for a coverage effective date of October 1, 2022.
  The NCD dental plan is a PPO dental plan which provides both in-network and out of network coverage.  Members will pay less out of pocket if they utilize an in-network provider.
  
  When we received the member complaint, it was escalated to one of our senior representative.  She contacted the member to discuss the issues he was having.  She explained to him that NCD processes the enrollments and handles billing and customer service for the ********************** plan. She advised him who the insurance company is as well as who the claims payor is. She also explained to him that the plan is a PPO plan and how he could utilize the benefits in or out of network.

  During conversations with the member, he stated that he had another dental plan.  The NCD representative advised him that he can use the NCD dental plan as secondary coverage and that the NCD dental plan would coordinate benefits with the primary dental plan.

  The member also stated that he had some work done last year.  He said his other dental insurance plan paid some of the cost of the dental services and he paid the balance. The representative checked with the claims payor for the NCD dental plan and found they had no claims for the member.

  The member advised the NCD representative that he has additional dental work that he needs to have done and wants to continue to use his same dentist which is out of network for the NCD plan.  The NCD representative advised him that she would contact his dental provider and work with them to coordinate his benefits between his primary dental insurance plan and the NCD dental plan. She advised him that she would also ask the dental provider about his dental claims from last year to see if there might be any benefits payable under the NCD dental plan.

  The NCD representative was able to speak to the members current dental provider and explained that she wanted to work with them to assist the member. The dental provider advised the NCD representative that the member had some work done in September 2022 that was partially paid for by the dental plan.  The NCD dental plan coverage was not effective until October 1, 2022, so the work done in September 2022 would not be covered under the NCD plan. He also had some other work done after that,but the primary dental plan paid 100% of the claim. Since the primary dental plan paid 100% of the other dental services, there would be no additional benefits paid from the NCD plan.

  The NCD representative contacted the member and provided him with the information that she obtained from the dental provider. She also advised the member that she would work with him and his dental provider going forward to assist with any future claims that need to be filed for the NCD dental plan.  The member seemed to be satisfied with the assistance he was given.  If he needs any further assistance he has the contact information for the NCD representative that assisted him as well as the general member service phone number.

• Initial Complaint

  10/06/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I emailed and called NCD Agency to delete my OLD payment methods, so I could upload my new payment method and the company refused to delete my payment methods. They stated, it was a HIPPA violation. Which I know that's NOT a HIPPA violation to delete my payment methods out of my account. They refuse to delete important information like that. They said, they will store all payment methods until the account is closed. The company also refuses to let you talk to a supervisor or a manager to discuss the matter.

  Business response

  10/20/2023

  NCD is a leading dental and vision program providing best-in-class dental and vision insurance products underwritten by A+ rated insurance companies. NCD provides enrollment services for independent agents, and billing and customer service for insurance companies that we work with.
  
  The member and her husband were enrolled in a dental and vision plan which requires the monthly payment to be made via automatic credit card or ACH payments. At the time of enrollment, the members chose to make their monthly payments via credit card.
  
  The payment that ran on May 30, 2023, declined.  The credit card decline reason from the merchant provider stated, Pick Up Card.  This reason code either means that there is suspected fraud on the credit card, or the credit card was lost or stolen.
  
  The members dental and vision plans were eventually cancelled due to the members non-response to the declined payment notices that were sent by NCD.
  
  The member called NCD member services on August 10, 2023, asking to reinstate just the dental plan.  The member provided a new credit card number, and the past due payments were run, and the dental plan was reinstated.
  
  NCD received a message from the member on October 3, 2023, stating they wanted to add a new method of payment and delete the other methods of payment from their account.  An ****************** representative responded advising that the methods of payment on file could not be deleted.  However, once a new method of payment was added, the previous method of payment would be deactivated so no further payments would run on that account.
  
  The member sent another message on October 4, 2023, again asking to delete the methods of payment from the account.  An ****************** representative responded advising that the methods of payment on file could not be deleted per HIPAA policy.  However, once a new method of payment was added, the previous method of payment would not be used again without the member's consent.
  
  The members daughter called NCD member services on October 5, 2023, to provide a new method of payment and asked that the previous methods of payment be deleted from the account.   The NCD representative responded advising that the methods of payment on file could not be deleted.  The daughter did not like the response, said a few choice words, and hung up.
  
  The NCD representative that spoke with the member on October 4, 2023, used the incorrect terminology when trying to explain why the credit card number cannot be deleted.   Credit card processing is subject to Payment Card Industry PCI compliance not HIPAA compliance.  NCD is compliant with all PCI requirements.  To be PCI compliant, all digits of a credit card number must be masked or hidden from view except for the last 4 digits of the credit card number.  Therefore, once the initial payment is entered and ran, NCD employees are not able to view the entire credit card number or the *** code. They can only view the last 4 digits of the credit card number and the expiration date.
  
  PCI requirements also state that cardholder data can only be stored for a legitimate legal, regulatory, or business reason.  NCD has legitimate legal, regulatory, and business reasons to retain the credit card number whether active or not.  There are several situations where NCD receives notices from banks, credit card issuers, law enforcement, etc., and must provide information regarding credit card transactions to these entities.  If a credit card number is deleted from NCDs system, NCD would not be able to provide the information requested.
  Below are just a few of the reasons why NCD must maintain the credit card number:
  _Cardholder files a chargeback with their credit card issuer.
  _Cardholder reports the credit card stolen.
  _Cardholder files a police report claiming fraud.
  _Cardholders identity is stolen and someone other than the cardholder is using their credit card.
  
  In the case of one of the credit card information that the members and their daughter are asking to delete, the credit card was flagged as a Pick Up card. If a credit card issuer or law enforcement were to ask for information regarding this credit card, NCD would have to be able to provide that information.
  
  The members need to advise NCD if they would like to keep the dental plan active and if so, they will need to advise NCD if the last credit card number provided on August 10, 2023, can be used for their September and October payments, or if they want to provide a new method of payment.  To avoid the dental plan being cancelled back to August 31, 2023, the members will need to contact NCD no later than October 31, 2023, to advise if they would like to continue the dental coverage and if so, what payment method they want to use. Since the dental plan has already been cancelled and reinstated once, if the dental plan is cancelled again, NCD will not be able to reinstate the dental plan. Tell us why here...

• Initial Complaint

  05/01/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have filed a claim with NCD dental 4 times and they keep telling me they did not get it. I filed in December, January, March and April only to be told they did not get it. NCD will not allow me to fax nor email the claim. I have been told different stories at a time, Now they are telling me that their system is down when I call to inquire about my claim to keep from discussing the problem. I have paid monthly for over a year for this dental insurance but they refuse to pay out towards the claims as promised. I have been told lies from the beginning about NCD dental paying $5000.00 towards implants after a year of paying for NCD dental. Now I am told they will not pay and that I was mislead. I would like to at least get back the money or a refund for what I put into this company.My name is ******************* member ID # *********

  Business response

  05/12/2023

  NCD is a leading dental and vision program providing best-**-class dental and vision insurance products underwritten by A+ rated insurance companies.  NCD provides enrollment services for independent agents, and billing and customer service for insurance companies that we work with.  NCD is not an insurance company and does not handle claims administration or processing and payment of claims.

  
  An independent agent enrolled the member in a dental plan and vision plan which are serviced by NCD.  The enrollment was electronically submitted to NCD on May 1, 2021, for a coverage effective date of June 1, 2021.
  
  The members daughter has been calling NCD member services regarding her mothers claims, and the NCD representatives have been trying to assist her. If they were not able to assist her, they transferred her to the claims payor for assistance.

  
  An NCD representative never advised the member or her daughter that the claims would not be paid.  We were advised by the claims payor that they never advised the member or her daughter that the claims would not be paid.
  NCD has been advised by the claims payor that the claim for date of service December 19, 2022 was paid to the dental provider on December 22, 2022.  The claim was paid based on the provider being within the network. An explanation of benefits was mailed to the member on December 22,2022.

  
  NCD was advised by the claims payor that the claim for date of service January 3, 2023, was reprocessed and was paid to the dental provider on May 5, 2023.  This claim was paid based on the provider being out of network. The members out of pocket expense could have been reduced if the dental provider was in network.  An explanation of benefits was mailed to the member on May 5, 2023.

  
  NCD apologizes to the member and her daughter for their frustration regarding the claim submission for date of service January 3, 2023.   The member can call NCD member services with questions she had regarding the claims.  If the NCD representative is not able to answer her questions, they will get the claims payor on the phone for assistance.

• Initial Complaint

  04/11/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Provided ncd with reguired documents for waver of waiting period of major dental work. Contacted company numerous times always getting told different lies.

  Business response

  04/24/2023

  NCD is a leading dental and vision program providing best-in-class dental and vision insurance products underwritten by A+ rated insurance companies.  NCD provides enrollment services for independent agents, and billing and customer service for insurance companies that we work with.  NCD is not an insurance company and does not handle claims administration or processing of claims.

  
  The members complaint appears to be in regard to the documents that she submitted for proof of prior coverage (****) to get the 12-month waiting period waived for major services.

  
  NCD does not make the final determination as to whether the 12-month waiting period can be waived. That determination is made by the insurance company or their respective claims administrator.  According to NCDs records, the member or her spouse submitted several different **** documents between the period of February 21, 2023 March 21, 2023.

  
  NCD member services sent an email to the member on March 21,2023, advising her that all of the **** documents were received and forwarded to the claims administrator for their review. She was also provided instructions on how to access her member portal to review her waiver status.  The members husband called NCD member services on April 10, 2023, and wanted to know the status of the waiver for the 12-month waiting period.  The NCD representative contacted the claims administrator with the members spouse on the phone and was advised that the waiver is pending and they would contact the member once the waiver was either approved or denied.

  
  An NCD member service supervisor contacted the claims administrator today, April 24, 2023, to check on the waiver status and was advised that the waiver of the 12-month waiting period was approved.
  If the member has covered dental work done by an in-network dental provider, she will receive 50% off of the contracted dental rates.  If the member has another dental policy, the NCD dental plan will coordinate benefits with the primary dental plan, which could reduce the amount the NCD dental plan would pay toward the dental claims.

  
  The member can contact NCD member services with any additional questions that she may have.

• Initial Complaint

  09/30/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  NCD is refusing to process my claim for frivolous reasons. This is turning into a NIGHTMARE! I have been trying to have my claim processed since June 2022 and now they are telling me for the FIFTH time to resubmit my claim! September 30, 2022, I spoke with Nelmer at NCD (call reference #XXXXXX) about the denial of the FOURTH and latest resubmission (claim no. XXXXXXXXXXXX) and he stated the resubmitted claim was rejected because they cannot see my last name and that ADA Claim forms must be hand written! This is the second time that a resubmitted claim was reject for such a frivolous reason! (see claim XXXXXXXXXXXX) That was the FOURTH reject resubmission since June 2022. The ADA claim form submitted to NCD was typed out by my dental provider. I fill out my name and NCD membership information in the two boxes at the very top. There was no reason to deny this claim for such a frivolous reason and burden me with having to resubmit this claim a FIFTH time! NCD has received all the required information to process my claim: (1) NCD received a Detailed EOB from Deltal Dental; (2) NCD received a Proof of Prior Coverage from Delta Dental; (3) NCD was provided a completed ADA Claim form typed up by my Dental Provider; (4) NCD stated that a Predetermination NOT needed since they are my SECONDARY DENTAL COVERAGE! BE WARNED: On 04/22/22 an NCD Agent could NOT answer my questions about the need for a predetermination and HUNG UP ON ME 3 TIMES! I called back a fourth time and got help from someone else in customer service who stated that a PREDETERMINATION was NOT needed since NCD is my SECONDARY insurance. On 09/05/22-09/08/22 I could NOT get any assistance because their computers where DOWN ALL WEEK! A customer service representative I spoke to on 09/09/22 promised a follow up on Monday 09/19/22 never heard from her again! THE NONSENSE MUST STOP!

  Business response

  12/28/2022

  Business Response /* (1000, 5, 2022/10/14) */ NCD is a leading dental and vision program providing best-in-class dental and vision insurance underwritten by A+ rated insurance companies. NCD Agency provides enrollment services, billing and customer service for independent agents, and insurance companies that we work with. NCD is not an insurance company and does not process or pay claims. The member self-enrolled on February 21, 2022, in the NCD dental plan for a coverage effective date of April 1, 2022. The member was emailed a welcome letter on February 22, 2022, and the member opened the email the same day. The welcome letter provides a link to the member portal, where the member can review their plan information and benefits, download a temporary ID card, and view their billing and payment information. The member has contacted NCD member services several times regarding proof of prior coverage, predeterminations, and claims. NCD did advise her that the 12 month waiting period had been waived for her and that a predetermination is not required. However, if a member is going to have costly major services done, it is better to get a predetermination done, so that you will know what the insurance company will pay and what you will have to pay out of pocket. This is especially important when you are using an out-of-network provider and coordinating benefits with a primary dental plan. We also checked our call logs and recordings and none of the NCD representatives hung up on the member and NCD's computer were not down as all during this time period. Since NCD is not the claims payor, the member was transferred to the claims payor, MBA, for the calls regarding claims payment. After receiving the complaint, NCD contacted the claims payor for the dental plan to see what the issues are in getting the claim processed. Since the member has a primary dental plan, and the NCD dental plan has a coordination of benefits provision, MBA advised the member that they would need a complete EOB, from the primary dental carrier. MBA advised that the first EOB received on September 16 was only a partial EOB and they requested the complete EOB again. MBA stated that they received a claim forms with the name handwritten on the forms. The claims are scanned into a claims system, and the scanner could not read the name, thus the claims were rejected. MBA has advised us that they have now received the complete EOB and a typed claim form. The claim is now being processed and should hopefully be completed by the week of October 17, 2022. The member did advise an NCD representative that she was using an out-of-network provider. When you use an out-of-network provider, the member does not receive the benefit of the in-network negotiated rate and the member is responsible for paying the difference between the dental provider billed rate and the network negotiated rate. Since the NCD plan is the secondary dental plan, the amount that is paid by the NCD dental plan, is coordinated with what was paid by the primary dental carrier. The member will receive a complete EOB advising of how much was paid as soon as the claim has finished processing.

• Initial Complaint

  08/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I signed up for a dental plan as a secondary form to pay for a procedure that I was having on March 1, 2022. The representative at National Care Dental asked if I had a primary insurance. I answered yes because I am under my husband's dental plan with BCBS SC. I asked if there would be a waiting period. I was told by the National Care Dental representative that they would waive the 1 year waiting period for the procedure for me. NCD collected $82 per month for the yearly policy. A procedure was performed on me from Solomon Dental Care, claim number: XXXXXXXXXXXXX by Dr. Brad Peper in the Careington Network. The total was $5199.00 of which my BCBS SC paid $2646,00 and NCD paid $0 leaving me with a balance as patient responsibility $2553.00. I strongly believe I was mislead when I signed up for this policy with NCD. I was told more than once that they would waive the waiting period but they have not. The only reason I looked for a secondary dental insurance was because of my impending dental procedure on March 1st 2022. I would not have signed up with NCD if I knew there was a waiting period they would not waive but NCD said they would.

  Business response

  10/10/2022

  Business Response /* (1000, 5, 2022/08/19) */ NCD is a leading dental and vision program providing best-in-class dental and vision insurance underwritten by A+ rated insurance companies. NCD Agency provides enrollment services, billing and customer service for independent agents, and insurance companies that we work with. NCD is not an insurance company and does not process or pay claims. An independent agent enrolled the member, in a dental plan which is serviced by NCD. The enrollment was electronically submitted to NCD on February 8, 2022, for a coverage effective date of March 1, 2022. ID cards and plan information were mailed to the member on February 8, 2022. An enrollment confirmation was emailed to the member on February 8, 2022, and was opened by the member the same day. The enrollment confirmation provides the name of the independent agent that enrolled the member, the products enrolled in, the coverage effective date, billing information, and other information regarding the dental plan. The enrollment confirmation includes the following information regarding the 12-month waiting period: "There are no waiting periods for covered preventative and basic dental services. There is a 12-month waiting period for covered major dental services. If you had previous PPO or MAC dental coverage prior to your enrollment in the NCD dental plan and did not have a break in coverage, you may be able to get credit for the number of months you had continuous coverage toward the NCD major services 12-month waiting period. If your proof of prior coverage was not selected at the time of enrollment, it must be submitted to Member Care within 30 days of the plan active date." The member was emailed a welcome letter on February 9, 2022, and the member opened the email the same day. The welcome letter provides a link to the member portal, where the member can review their plan information and benefits, download a temporary ID card, and view their billing and payment information. The welcome email also includes the following information regarding the 12-month waiting period: "If you had previous PPO or MAC dental coverage prior to your enrollment in the NCD Dental plan and did not have more than a 30-day break in coverage, you may be able to get credit for the number of months you had continuous coverage from your previous provider towards the NCD major services 12-month waiting period. If proof of prior coverage was not selected at the time of enrollment, it must be submitted to Member Care within 30 days of the plan's active date." After receiving the BBB complaint, NCD contacted the insurance agency that the independent agent works for, and requested the call recording of the enrollment. In the call recording from February 8, 2022, the member advised the agent that she had dental coverage through her husband's job, but he lost his job in November. She stated that he got his job back in December and was able to get dental coverage with BS/BS. The member stated she wanted a secondary coverage as she needed to have some major dental service done. The agent advised the member that Major Services are paid at 50% of the PPO network contracted rate, and that there was a 12-month waiting period before the plan will pay the 50% benefit for Major Services. However, the agent advised the member that even if she had a 12-month waiting period, as long as she went to an in-network provider, she could still get the PPO contracted rate which would be up to 40% off the billed rate. The agent did not ask the member for the dates that she had prior dental coverage. Had the agent done so, that information could have been entered at the time of enrollment to see if the member would have qualified for a waiver of the 12-month waiting period for major service. NCD member services received a call on February 28, 2022, from a providers office requesting to verify eligibility and benefits for the member. The NCD representative went over the benefits with the provider and advised the caller of the 12-month waiting period for major services. The representative advised the caller that if the member had prior dental coverage, the member would need to provide proof of the prior dental coverage to get a waiver for the 12-month waiting period. The member called NCD member services on February 28, 2022, and stated that her dental office called NCD and was told she had a 12-month waiting period for major services. The member was upset and stated that she wanted to cancel. The NCD representative advised the member that there is a 12-month waiting period for major services. The member was also advised that if she had prior coverage, she could provide proof of that coverage and get a waiver for the 12-month waiting period. The member stated that she was not aware that she had to provide proof of prior coverage and become very upset. The member then disconnected the call. NCD received an email from the member the evening of February 28, 2022, stating that she was providing proof of her prior dental coverage so that she could get the 12-month waiting period waived. NCD responded back to the email on March 1, 2022, advising that there was not an attachment received for the proof of prior coverage. The email also stated that the 12-month waiting period would be approved, however, MBA which is the claims payor, would require proof of prior coverage. The member was advised the proof of coverage should include a schedule of benefits for the plan as well as a letter of credible coverage from the prior insurance company. The member never responded to the email and NCD nor MBA have received the member's proof of prior coverage. The member called NCD member services on March 14, 2022, stating that she was having issues with the previous provider that she saw and stated that if the provider submitted and claims for her, not pay them. She stated she also advised BC/BS to not pay the claims. The NCD member service representative transferred the member to MBA, which is the claim payor. The member called on August 4, 2022, stating that her claim from March 21, 2022 was denied due to the 12-month waiting period and it should not have been because she had BC/BC as her primary coverage. The member was upset and advised the NCD representative to cancel the dental plan. The dental plan was cancelled effective August 31, 2022. NCD checked with the claims payor, MBA, regarding the status of the member's claims. MBA advised that the claim for date of service March 21, 2022, was processed as in-network and the provider billed rate was reduced from $5,199.00 to $2,553.00. However, no benefit was paid due to the 12-month waiting period. MBA also advised us there are two claims that were paid for the member. A claim for preventive services on March 7, 2022, which the provider billed $131.00, but was reduced to the PPO contracted rate of $65, and MBA paid the provider $65, and the member paid nothing. The 2nd claim was for preventive services on May 30, 2022, which the provider billed $339.00 but was reduced to the PPO contracted rate of $164.00, and MBA paid the provider $164.00, and the member paid nothing. Also, all of these claims were submitted by a provider that never contacted NCD to verify benefits for the member prior to rendering services. Had the provider called NCD or MBA, they would have been advised of the 12-month waiting period for major services. An NCD supervisor will try and contact the member on Monday, August 22, 2022, to see if they can get the proof of prior coverage from the member. NCD can then send the proof of prior coverage to MBA and ask them to waive the 12-month waiting period and reprocess the claim. However, even if the 12-month waiting period is waived, since the member has a primary dental plan, the NCD dental plan is secondary and coordinates benefits with the primary dental plan. The coordination of benefits provision is in the schedule of benefits/cert that the member can access through her NCD member portal. The supervisor can also explain this further to the member.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩