Complaints

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• Initial Complaint

  Date:02/01/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  We signed up for medical and dental insurance for 2023, because we upgraded our medical from 2022 they should of reapplied for the dental that we wanted to stay the same. They are telling us that they didn't know they had to reapply so now we don't have dental insurance for 2023. We received about a $600 bill for 2 visits to the dentist. We go to these professals so we know we are completely covered and they dropped the ball. Thanks for your help in this matter.

  Business Response

  Date: 02/02/2023

  First and foremost, I do apologize that the clients were unhappy with their experience.  I have investigated the complaint and asked the agent whom the clients were working with to respond.  His response follows:  "I apologize for the inconvenience these clients are experiencing regarding their dental coverage in 2023.  I originally assisted them with signing up for qualified health plans as well as dental coverage in December of 2021 for coverage in 2022 through the Federally Facilitated Marketplace.  In December of 2022 we met to review coverage options for 2023.  I assisted them with updating their income which is reported on their applications for the purpose of tax credits (premium reduction) and helped them select a medical policy for 2023.  We did not discuss dental coverage during our 2022 meeting as we were all assuming that the current policy would continue.

  On 1/31/23, I was notified by the clients that they had in fact lost their dental coverage at the end of 2022.  After contacting Delta Dental to see about the possibility of a reinstatement of the same policy with no gap in coverage, I was informed by Delta that they would not be able to do so due to the fact that the dental policy was terminated by the marketplace with no reason for the termination given.  Because we were unable to reinstate the original dental policy, I advised the clients the best course of action was to reapply for the same policy.  I was able to meet with them the same day, and they agreed to apply for the same plan through Delta Dental, at the same premium amount, with the coverage starting 2/1/23.  This means that there was a gap in dental coverage of approximately 1 month, not long enough for the new policy to require any waiting periods for certain dental services.  On 2/1/23, one of the clients provided me a copy of a notice he received from Delta Dental dated 10/21/22 regarding the need to re-enroll in their dental coverage if they make any changes to their medical coverage.  Delta Dental did not communicate this to me as the agent, nor did the client reach out to me at that time, therefore I was not aware of the necessity to re-enroll in the dental policy if changes were made in the medical policy.  I learned that this need to re-enroll is only applied to policies obtained through the marketplace and does not affect any policies where the application was submitted directly to Delta Dental."

  Unfortunately, this was a learning experience for all, and I have advised the other agents who work for Informed Choice of this possible issue if enrolling people in separate dental plans through the marketplace.  I have advised them to instead be sure to take separate applications for dental plans to avoid having any issues with this in the future.  The client did ask our agent what the agency was going to do about the $600 bills that he and his wife incurred for cleanings when the policy was not in force in January of 2023, and I advised our agent to let him know that insurance regulations prohibit us from paying them for these claims.  Again, I do apologize for the clients' inconvenience.  

  ***********************, President

  Informed Choice