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Insurance (Dental)

Date: 2/20/2019 8:08 AM (PST)

My dental insurance company does not want to pay for a covered expense, do you get involved with these kind of disputes. Also, if you don't,can you give me a referral.
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Date: 2/20/2019 12:26 PM (PST)

Hello Derek. We would contact your dental insurance company with a complaint and ask that they address the allegations raised and provide a reason why they do not want to pay for the covered expense. The entire complaint process can take 30 days. We cannot guarantee a resolution will be reached, but filing a complaint is a good first step: https://www.checkbca.org/file-complaint

To escalate the complaint further, I suggest contacting the California Department of Insurance (CDI): CDI assists consumers with matters regarding improper denial or delay in payment of a claim, and other claim related issues: http://www.insurance.ca.gov/01-consumers/101-help/hcpcomplaints.cfm

To ensure proper review of your complaint, the CDI requests consumers to please provide copies of the following:

• Claim forms submitted to the insurance company
• All correspondence between the provider and the insurance company
• The patient’s insurance identification card- both sides
• Provider’s contract with the insurance company, if applicable
• The patient’s Assignment of Benefits, if applicable
• Completed Health Care Provider Request for Assistance (HPRFA) form

I hope this information has been helpful. Please feel free to contact me directly at vantillon@checkbca.org if I can be of further assistance.

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