October 2011

Special Investigating Unit

To Whom It May Concern:

My husband is a Los Angeles City Firefighter & our family's dental insurance is United Concordia DHMO through the United Firefighters of Los Angeles City Local 112, which provides this dental insurance.

I write to you today to convey my concern at the matter in which patients are being misled by United Concordia DHMO Dental Providers and request an urgent investigation to protect all consumers.

The events detailed below (which are just a couple examples out of many to explain) have not only left me with needed dental work to be preformed, & disappointed but they are also incurring the patients an inconsiderable cost, time & stress.

On numerous visits to 5 different United Concordia DHMO Dental Providers when dental work was to be preformed the insurance managers, would come into the room to speak about cost of the procedures and what was covered by insurance and co-payments. The insurance managers would only give quotes on the procedures that the dental office was going to make money on. They never quoted what the insurance covered at 100% and/ or offered these services

Example (1) when I was told I needed a bridge on the top right I believe tooth #s 2, 3 & 4 the insurance manger told me that I had a co-payment of $1500.00. I asked if this is what their fee schedule said and was told "yes."

I then proceeded to call the United Concordia Ins right from the dental chair and verify coverage and the customer service rep told me I was covered at 100% with no co-pay.

Example (#2) When I was told I need a crown on my bottom right tooth I believe tooth # 31 I was told that my co-pay was $300.00. Again I called the United Concordia customer service and the rep told me I was covered for porcelain to fuse metal crown, which is cover 100% with no co-pay. I was not even told of this option. Once again they told me that this wasn't on their fee schedule. I at times even put the Ins. Manager's from two of the five offices on my cell phone with the rep at United Concordia.

Knowing I was given incorrect information on every occasion I diligently called the insurance co. and had to check all coverage.

I was refused service at one dental office saying they could not guarantee their work after questioning the fees and was told and denied service at another dental office cause they weren't making and losing money on me due to my insurance.

There are many more detailed & worse examples but too much to put in an email.

I find it amazing that dental offices that are listed as a provider from and insurance company that is supposedly a reputable company would sink to using the techniques of an overcharging operation. Therefore I can only draw the conclusion that the DHMO Dental providers are using a deceptive sales practice which is designed to lure potent ional patients into thinking that what they are offering is the only option so they can make money on what they want to sell you.

I am sure that many people instead of going through the hassle of questioning or don't even know to question this type of discrepancy simply just let it slide. I am certainly not one of them.

I trust you will investigate and/all specific violations of the dental practice act concerning the DHMO dentist of CA. to the fullest to protect other consumers against this kind of fraud. Please advise me whether in fact it is the protocol to provide inaccurate information to patients so the dental office can benefit from profit.

I look forward to receiving acknowledgement of this letter. Please don't hesitate to contact me if you need further information.

Review about: United Concordia Dental Dental Insurance.

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You're cheap, dental service is never cheap or cover 100% by ins. Dental office needs profit to pay to the employee, the supplies used for your bridge and crown, the lab fee, etc.

The prices you mention for copay wasn't bad at all for DHMO ins.

United Concordia don't pay good at all. Any dental office has the right to deny from seeing you by the way.

Miami, Florida, United States #751356

This kind of business practices should be reported to the State attorney's office for investigation.

New Orleans, Louisiana, United States #637981

Ins only informs of coverage amounts and if your plan says it covers 100%, it is only of your plan fee schedule which is not given to the dentist but must be supplied to the dentist from you. I deal with ins every day and they will not confirm anything until they pay on it....pre-treatment estimate or not!

It is your responsibility to know your ins plan and what is covered, frequency limitations, exclusions, etc. You were denied because the dental offices realized that they are being screwed by your insurance company.

We have to have patients sign a letter stating that they know they are responsible if United Concordia considers their treatment "unnecessary". You should determine what is necessary for yourself and not your insurance....their goal is to make money not take care of you needs.

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