ComplaintsforAnthem Dental

• Initial Complaint

  02/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I submitted an application for Dental Net 3000D, which said that the start date of coverage was going to be 2/1/2024, but then my application was not approved by 2/1/2024. Since I needed coverage right away, I tried to cancel the application and called customer service, but the agent could not find my application (N01706738001407D). My application then went to "approved" on 2/2/2024, by which date it was too late. I called and texted the Anthem membership team... but, again, the agent could not find my membership account... and said the application was still pending/being processed.I expect Anthem to cancel my enrollment (if, in fact, I am enrolled) and reimburse my $16 monthly fee.

  Business response

  02/08/2024

  January 26, ****
  
  
  
  Complaint ID: ********
  Member Name: ************************
  Member ID Number: *********          
  
  ************************************,
  
  Anthem Dental has finished reviewing your request for assistance with the above-named customer, ************************. He stated that he was upset that his policy was not active as of February 1, ****, and he wanted to cancel his policy and he expected a full reimbursement of his $16.00 monthly fee.
  
  Our records show that ************************ s policy was retro termed as of February 1, ****, and a payment in the amount of $16.00 was refunded to him on February 7, ****, to the card we had on file.
  
  We apologize for any delays or inconvenience he may have experienced in his efforts to obtain quality care and service, and we thank you for bringing this to our attention.
  
  Sincerely,
  
  
  
  *****************************
  Grievances and Appeals
  Grievances and Appeals Department 

  Customer response

  02/08/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Regards,
  
  ************************

• Initial Complaint

  01/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have coverage with Anthem Blue Cross Dental. i understood the waiting period to be 12 months from date of coverage. NO WHERE is there any information showing effective date of coverage other than the monthly billing where it states "Start Date" 11/10/2022". I never received anything showing an effective date -only a Summary of Benefits and an ID card (neither contain an effective date of coverage). Assuming from my paperwork that my effective date was 11/10, I had my crown done on 11/13. Now I'm receiving an EOB that my coverage was denied and the effective date is 12/1. NO where on website (where I pay bill) is there Certificate of Coverage. I tried logging in to the Anthem site today and received an error (see attached). Had to get technical support and it appeared once I WAS logged in, I had never logged in prior. There, on the ID card page, the 12/1/2022 effective date appears. BUT printed out, NO effective date shows. This is poor and misleading practices. In addition, I received TWO weeks notice of a 25% increase in premiums! I believe that should be illegal according to insurance commissioner rules.

  Business response

  01/09/2024

  Good morning

  Please see our response to the BBB complaint. Thank you. 

  Customer response

  01/09/2024

  Complaint: ********
  
  I am rejecting this response because:  There is nothing I can see on the response.  It just says "see attached" and I can not view the attachment.

  Please resend attachment so I can respond.
  
  Regards,
  
  ***** ******

  Business response

  01/10/2024

  Our apologies for not including the entire response. See the attached response. Thank you. 

• Initial Complaint

  06/14/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My son got braces on 05/20/2021. In July of 2021 Anthem sent the orthodontist a letter saying they won't cover the cost due to having primary insurance. My primary insurance Cigna has pay all the claims for my son's braces. Anthem has still been denying him saying they need EOBs from the primary insurance. I talked to an agent on 03/30/2023 and confirmed that they have all the EOBs and nothing else was needed and the claim would be paid within 30 days. I reached out on 05/02/2023 and the claim was still not processed because they needed the claim form to be updated from the orthodontist to state the correct subscribers name and EOBs from the primary insurance. This was all sent over on 05/02 and they said it would processed within 10 days. On 05/19, the claim had still not been paid claiming they needed the same information and it was again sent in to them. They denied the claim saying they need the EOBs. On 06/05 I talked to a supervisor with Anthem and confirmed they have everything and the claim would be processed. They denied it again saying they need EOBs. I faxed the EOBs to them on 06/09/2023 and they confirmed they have them and it can be another 30 days for them to process the claim. It should not take over 2 years to pay a claim.

  Business response

  06/23/2023

  Regarding:Anthem Member Complaint
  Complaint ID: ********

  
  Dear Better Business Bureau,      

  This letter is to respond to the complaint concerning orthodontic claims for a dependent.After careful review, we have the following information to share. 

  According to our records, the requested primary Explanation of Benefits from the patients primary carrier have been received. Subsequently, all impacted orthodontic claims for this complaint have been reprocessed in accordance with the terms and conditions of the members secondary dental plan.

  Updated Explanation of Benefits statement(s) should be received within the next 7 to 14 business days. Please refer the complainant to the Explanation of Benefits statement for details and payment information.

  The level of benefit will be contingent on the limitations and conditions of the dental plan. The payment will not exceed the patients maximum.

  Member Services can be reached at the toll-free number listed on the patients ID card if there are any questions.

  We hope the preceding explanation is helpful.
  Sincerely,

  ***********************
  Grievance Analyst
  Grievances/Appeals 

• Initial Complaint

  01/16/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Date of the transaction: 12/30/2022 The amount of money you paid the business:The Anthem Dental Insurance is suppose to cover 100% for any basics/Preventive ************ that was provided in-network. What the business committed to provide you:The insurance is suppose to cover 100% for any basics/Preventive ************ that was provided. According to the law the insurance companies are not suppose to charge a deductible for preventive services. Nevertheless, the insurance company is charging a deductible of $50.00. The dentist office did the x-rays, exam, and performed basic cleaning. Insurance pays 100 % and no deductible. What the nature of the dispute is:The dental insurance companies, more than one, have started some fraudulent activity where they are charging individuals for deep cleaning and periodontal maintenance instead of giving the person the preventive services that the insurance company covers. If a person doesn't accept their claim, then the dentist is refusing to provide preventive service at all. They are fraudulently taking away individual preventive benefits, knowingly they are lying about a deep cleaning and periodontal maintenance is needed and refuse to send the preventive claim to the insurance company. I had to fight with the dentist office employees and dentist before they decided to go ahead and do the preventive service. Whether or not the business has tried to resolve the problem. No Now, they are trying to put the dental services my 22 year old son received in my name. I informed them that I don't want his services in my name by law it should be in his name. I am refusing this be done. Account/order/tracking number_ Patient name is ***************************** _ Phone ************. The dentist office is ************************************************************************************ ****************** Anthem Dental Claims #********, ***********************************************_ Phone ************** There was no reason for this type of action.

  Business response

  01/24/2023

  Please see our attached response. Thank you. 

*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. ↩