1 Jan, 2018 → by ClaimboUser271455
Coverage refusal
*SOLVED

3

I pay my premiums on time, and I comply with the requirements of my plan. I had dental scaling on both sides of my mouth, which AARP Delta Dental pre-certified as covered. I complied with their plan requirements as stated in my manual. After I had the scaling, AARP Delta Dental reversed itself and is now refusing to cover $100 toward the scaling. On June 1 2009 I filed a complaint with the Pennsylvania Insurance Department against AARP Delta Dental about this refusal. When I spoke to the Insurance Department agent handling the case on July 7, 2009, she said that AARP Delta Dental had requested, and been granted, an "extension" on the deadline for responding, saying they needed the extra time to gather their information to present to the Insurance Department. I am entitled to have this procedure covered. Through my dental provider's office, I have been told that AARP Delta Dental is claiming that I had scaling twice on the left side of my mouth, according to their records, and that's how they're justifying their refusal to pay. My provider, U of Penn Dental Clinic, says that they have provided AARP Delta Dental with accurate information, reporting that I had the scaling on both sides of my mouth, and that AARP Delta Dental pre-certified the treatment.
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