![]() Guardian is stating a Peer to Peer review was conducted on May 22nd, but a representative never spoke to her or any other representative of this dental office before agents of Guardian hung up on them,Reference numbers to these hung up calls are as followed:Jun e 13th 12:30 pm EST #************* Here is record from my dentist on contact to Guardian Mon - called insurance to see why the calim was still den even though we have sent everything they have asked for, insurance stated they require 5mm pockets fir SRP and i explained to them that the perio chart we sent shows 5mm pockets and more so it should have not ben **** ins agent is resubmiting allow **** days for cor, Ref number ************ **************** -claim is still denied call patient to contact her insurance company -PJ - Wed -Spoke to rep claim is still denied due to loss of evidence of bone loss need a time and date in letter form sent to dental consultant fax to set up a call back fax# *************-PJ Mon -spoke w/***************** due to lack of info processed with tooth showing bone loss in all 4 quads. The dental office was able to show this damage was sufficient with documentation sent 4 times, but each time my claim has been denied.Guarding Life Insurance requested a Peer to Peer review, but myself and the billing coordinator **************************************** has also been hung up on my agents of Guardian. A claim (#***********) was submitted and my insurance carrier "The Guardian Life Insurance Company of America" (Address PO Box ****** ******* ** **********) denied the claim stating there was not 5mm damage. In order for the BBB to appropriately process your response, you MUST answer the question above. I would like Guardian to provide an explanation through the BBB Complaint process as to how they are going to resolve my complaint, not just to copy and paste the form response they have done three times now when contacted by the BBB. I tried speaking to them directly several times and none of the responses I was given were accurate or acceptable, nor was I treated fairly or courteously. Also, if I thought speaking directly to Guardian would help me, I would not have filed a complaint with the BBB. Guardian Life Insurance has not responded through the BBB Complaint process other than repeatedly to say "customer ********************** is important to us we will reach out directly to the complaintant." I find this unacceptable because there is no record through the BBB of what actions or determinations the company makes to try and resolve my complaint. I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because: ![]() ![]() I would like the entire $135 for the services covered as is stated in my plan description (which is the only plan document available to me from Guardian). ![]() I was never provided a written denial of my claim, I was never provided documentation stating how the fee schedule was determined (all of which is required to be provided to me according to Guardian), and nowhere in my plan description does it say that prophylactic cleanings will only be covered according to a vague and nebulous "fee schedule". Despite me telling Guardian all this, and the fact that no dentist in my area only charges $74 for a cleaning, they still stated that their fee schedule was accurate based on my location. My dentist literally stated they could not remain in business if they only charged $74/cleaning and the reason they are out-of-network with Guardian is because of their fee schedule rates. Guardian denied this appeal (with no notice to me) and stated the reason for the low rate on their fee schedule was determined by the location of my dentist. I appealed this determination, specifically the fee schedule and how that price is determined, as no dentists within 100 miles of where I live charge a rate that low for prophylactic cleanings. However, Guardian only covered $74 out of a total charge of $135 for the routine cleaning, claiming that they did in fact cover 100% of the claim because $74 was the standard rate for the services according to their "fee schedule" (I was also told at one point that the $74 was "reasonable and customary" for routine dental cleaning and thus also covered at 100%). My insurance plan states that such services are 100% covered for both in-network and out-of-network providers. This claim was for routine, prophylactic dental cleaning from an out-of-network provider. ![]() I filed a claim with my dental insurance company (Guardian Life Insurance Company of America) for services performed on 07 June 2023 in the *************** (Claim #***********). ![]()
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