Delta Dental

Well, not every company can be like LLBean. I had a frustrating experience with Delta Dental back in 2006. I almost didn't post this letter because after reading it a year later it seems particular and trivial, however it expresses my feelings a the time.

In response to the letter, Delta contacted me and offered to cover what they had originally promised me. I appreciate the way they handled my request.

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To Delta Dental:

On August 29th 2006, my dentist recommended that I have a NTI Nightguard made because I grind my teeth at night. Before I agreed to the treatment, I called Delta Dental to find out how much the Nightguard would be covered – because although the paperwork I was given from my employer was quite comprehensive, I was not fully confident how much I would be covered.

Therefore, I called Delta Dental and asked them “how much will you cover a NTI Nightguard, number D99490?” The customer service representative on the phone told me the following: “Participating providers cover 90% and non-participating providers cover 80%.” I then confirmed with him that since my dentist is a participating provider (he had all of my information at the screen in front of him), I would them be covered 90%. I hung up the phone confident that Delta would cover 90% with no mention of a deductible.

However, after the procedure, on September 18, I received a bill for $148.60 from my dentist Amy Guthrie, DDS. Delta had only covered 80% with a $50 deductible.

I am quite disappointed in the service that I have received from Delta. I appreciate the fact that you have covered 80%, however, I was misled in how much I was expected to pay. I have been told that somewhere in the Delta paperwork, it states how much of this procedure is covered and that there is a $50 deductible. However, the fact that I took the time to contact a Delta representative and they then proceeded to give me faulty information is disappointing and frustrating.

• Why wasn’t my coverage clearly explained to me? I understand that I am responsible for figuring how much I am covered and that is why I made the effort to call before my treatment so that I could then base the amount of coverage on whether or not I would chose to have the Nightguard made.

• Why wasn’t I alerted to the fact that my dentist is a premier provider rather than a preferred provider? The Delta representative had all of my information and paperwork directly in front of him on the computer screen and could have clearly told me how I was specifically covered.

• Shouldn’t Delta be accountable to what they tell people and not just fall back on what is in the writing? The documentation Delta provides, while thorough, is quite confusing for the average individual. That is why I called – in order to clarify my coverage.

Therefore, I am asking that Delta cover what they committed to on the phone with me back in early September when I asked “how much am I covered?” and they told me 90% and did not mention a deductible.

I appreciate your time to consider my grievance. I look forward to hearing from you.

Sincerely,

Brian Mason