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GeoJ89
December 4, 2009
Lies about insurance
I have Delta Dental in Calif. I pre-determined Dentist was a Preferred Prov. which allowed me abt $450.00 of coverage. I get bill, turns out they are not, and I am out of benefits, I am charged the FULL amt. Office staff said they did not call Delta before treatment, I feel this tactic is a rip off becuase it's a way of making a lot more money, just make the consumer PAY! Which agency in Calif can help me? Where do I go to report them?
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DS Ortho
May 19, 2009
Changing ADA codes to pay minimum benefits
Our office has been billing Delta Dental for a long time and the past 2 years have been a little trying. When our office bills out for Full Comprehensive Orthodontic Treatment on Adolescent patients D8080 Delta Dental will change the ADA code to D8070 (phase I ortho code of transitional dentition) in order to pay out a lessor benefit amount. I usually catch it when I am missing payments and it isnt paying out the full estimated benefit based on the patients treatment fee and lifetime maximum. I have fought with them several times on several patients to the point of parents getting the insurance commissioner involved and I have contacted the ADA and the AAO to verify what I know is right... it is illegal for insurance companies to change ADA codes from what you billed them. They are trying to say they are basing it on the childs age! Which is irrelevent to the type of treatment a patient receives, children are not a robots each child is different and are at different stages of dental development which the ORTHDONTIST or DOCTOR knows, NOT an insurance company looking at an age and an ADA code to determine this. I want to complain to someone who can hold an insurance companies accountable from a professional/ dental office. Is there such an agency because I believe we are not considered the consumer?
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