Complaints

• Initial Complaint

  04/05/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I have dental insurance through my employer. Superior dental advertises 100% preventative care coverage in addition to $1,500 in dental expenses (see benefits summary from employer). I had a root canal that went above the $1,500 so I ended up paying the additional (not an issue). However in December of the same year my daughter and I went in for routine preventative visit/ie tooth cleaning with an in network provider. Superior dental denied my benefit for preventative care stating that since my dental expenses maxed with the root canal earlier in the year no preventative care was covered. Furthermore they did not request my dentist bill me at the preferred/negotiated dental rate of $85.00, instead they said they had no responsibility for the preventative care nor forwarding the preferred/negotiated rate to the dentist. (per conversation with superior dental on 4/4/2024.) From the benefits they boast including "Preventative: 100% in-network" this seems to be false advertising if the preventative coverage does not exist if you have a dental procedure in the same year.

  

  Business response

  04/09/2024

  April 9, 2024

  Better Business Bureau

  15 West Fourth Street, Suite 300

  Dayton, OH 45402

  Case: ***** *******

  Assigned ID: ********

  Dear ******* **:

  I am writing to respond to the complaint forwarded from your office on April 5, 2024. **** ******* states that she has dental insurance through her employer. Superior Dental advertises preventive care coverage in addition to $1500 in dental expenses. She had a root canal that exceeded above the $1,500 maximum so she had to pay the difference. **** ******* states her daughter went for a preventive visit/tooth cleaning with a network provider and her claim was denied stating that her dental care maximum was met with the root canal. She states that the preventive care being advertised at 100% is false advertisement.

  Superior Dental Care (SDC) appreciated having the opportunity last week to provide verbal explanation regarding your 2023 processed claims. As confirmed regarding your contracted benefits, dollars paid for dental services from the Preventive, Basic and Major categories all apply to the Contract Maximum; and your personal maximum was met for the 2023 benefit period.

  Your additional services received once the contract maximum had been met, even preventive services were considered ineligible. An allowable amount applies only to eligible services. Specifically, SDC’s Evidence of Coverage confirms that for non-covered/ineligible services the member is responsible for the provider’s full charge. An allowable amount was applied to all eligible, in network services and eligible preventive services were benefited at 100% (with no assigned coinsurance) affording significant savings. Four claims were paid and processed to meet the $1,000 maximum. One claim for ***** ******* in the amount of $441.00 was denied. The claim for your daughter appears to be processed towards the $1,000 maximum.

  Please reference the attached SDC Schedule of Benefits -Plan 1384 (associated with your 2023 coverage) and Evidence of Coverage, for additional verification.

  Please do not hesitate to contact SDC if additional explanation or confirmation of in-network discounts for eligible services would be helpful. SDC’s Dentist and Member Services team may be contacted Monday through Friday from 7:30am until 5:00pm at 800.801.4915.

  Sincerely,

  ******* ********

  Customer Resolution Specialist

  Appeal and Complaint Department

  Fax ***** ********

  Please see the attached response. 

• Initial Complaint

  11/03/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Superior Dental Care lies!!! The policy states that they would pay out 80% of Oral surgery. The bill was $471.00 and they gave us a check for $40.00. They stated that this is their amount. They lie to Dayton Public Schools Teachers, and their family. They do this over and over and state that it is "wrong coding" They know what they are doing and intentionally deceived our family who believed when we paid out of pocket that as per my husbands Contract which is through Dayton Public Schools a state government entity that they would pay the 80%. When asked why they did not pay out the contracted amount I was told I needed to be educated on their deception!!!! 80% of $471.00 is $376.00 as per my husband's contract. They have stated that they have their own allowed amounts but deceive a state government public entity Dayton Public Schools. and our family who trusted them not to commit deceptive practice. We are demanding they pay out at contracted amount!

  

  Business response

  11/09/2023

  Superior Dental Care (SDC) has had the opportunity to review the specific claim referenced in the complainant’s statement, as well as the dental benefits contracted through the subscriber’s employer. It was determined that based on the contracted coverage and the rendering of treatment by an out-of-network dental specialist, that the claim was accurately processed with assignment of the maximum eligible benefit.

  
  SDC does not dispute the accuracy of the coding included in the claim submission. Benefit eligibility was assessed based on the contracted coverage as detailed in the Schedule of Benefits for SDC Plan # 1118. (Reference attached copy.) Notably the plan description details the specific types of dental x-rays that are contracted for coverage (ie. bitewing x-rays, periapical x-rays, etc.) within the Preventive Services section; and includes the Specialist Examination details in the Basic Services section.

  
  Any non-covered service, such as the billed cone-beam x-ray, is the member’s full financial responsibility. [NOTE: While SDC would not refer to cone-beam x-rays as a “picture” as the complainant asserted in the supplemental complaint message; it is appropriate to refer to them as “images” consistent with the American Dental Association’s descriptors for these related services.]

  
  Additionally, on the second page explanation is provided regarding the manner in which out-of-network services are contracted for coverage. It specifically states that “Members receiving SDC payment for services performed by a non-participating dentist will be responsible for the full payment to that dentist. Any out of network service may be subject to a “balance bill” for any amount that the dentist’s charge exceeds SDC’s then current allowable amount for an eligible service.” This confirms that benefits for eligible services are not calculated based on the submitted charges when they exceed SDC’s allowable amount.

  
  SDC values the relationships established with the clients/employer groups served and is committed to accuracy in claims processing. In good faith, SDC adjudicated the received claim based on the contracted coverage and, even on further review, finds that no additional benefit/member reimbursement is eligible.

  Thank you for the opportunity to respond to the presented complaint.

  Customer response

  11/09/2023

  
  Complaint: ********
  
  I am rejecting this response because: You Superior Dental are Breaching the Contract. You are calling an XRAY and image and yet paying out on Images/XRAYS for all other people but not for our family as it is clear you don't pay out Contracted amounts. You also threatened to call my husband's HR anonymously as a retaliation effort due to you not wanting to pay claims. You have been reported to the necessary authorities for you retaliation. You need to immediately pay the agreed contract amount. We will be also reporting this to the ADA as you are now identified as a company who does not pay out on disabled children due to their disability you change XRAY to image, and DONT pay. You are crooks and liars! You have also been reported to MedMutual Fraud line for full investigation!
  
  Sincerely,
  
  ******** ******

  

  Business response

  11/16/2023

  Superior Dental Care (SDC) has processed all claims in accordance with the terms and conditions of the member’s dental coverage. Significant effort has been extended to assist and educate the member with an explanation of how the claims in question were processed and paid.  Absolutely no retaliatory actions have been taken towards this member. SDC will continue to address all related inquiries in the same truthful and forthright manner extended thus far and will process any future claims in accordance with the terms and conditions of the member’s dental coverage.

• Initial Complaint

  02/24/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  In October and November of 2022, I tried multiple times to cancel my plan through the app, the website, and phone voicemail message. None to avail. However, on January 10, 2023 a **** ****** emailed and said that he would get my plan cancelled. He said that because I couldn’t provide evidence of wanting it cancelled prior to December 2022, that’s when he would backdate the cancellation. Fine. However, I was still charged for January’s premium. Eight days later, instead of being refunded my January premium payment, I was charged a SECOND January premium! Later that day, a ******* ******* gave assurance that my plan had indeed been cancelled in December. **** then assured me I would see my money returned to me “next month.” On February 2nd, I was charged for a FEBRUARY premium! The case was escalated to an ****** ****** who, after a week or so of silence, let me know that I would have two cheques mailed to me to reimburse me for all the money wrongfully taken from my bank account. She said I would receive them both by February 16th. It is now February 23rd, two weeks after they were allegedly sent, and I’ve only received one of them amounting to only half of what I am entitled to. When I expressed my incredible frustration, Mr. Harder belittled my situation, said it probably “cost me another $30” and made a classist statement about how if I were nicer I wouldn’t be sweating “such small amounts of money.” Superior Dental Care is either a scam or completely inept. I’m not sure which would result in a likelier chance of me getting my money back and preventing a March premium auto drawn from my bank account.

  

  Business response

  03/02/2023

  Superior Dental Care (SDC) apologizes for the frustration and inconvenience experienced by the complainant. Unfortunately, SDC was not made aware of any issues until February 2. Since then, the issues described by the complainant have been corrected and we have confirmed receipt of the requested refund in full.

  A summary is provided below for reference.
  January 18, 2023: SDC terminated the complainant’s dental plan as of December 31, 2022 per their broker’s request.
  February 2, 2023: SDC received notification from the broker of billing issues and learned that the complainant had requested a termination date of November 30, 2022.
  February 3, 2023: The plan termination date was adjusted to November 30, 2022 and confirmation was provided to the complainant and their broker.
  February 9, 2023: Refunds totaling $121.04 were processed for the payments deducted for December, January and February, including one additional erroneous charge. Notification of the mailed refund checks was provided to the complainant and their broker.
  February 13, 2023: Complainant confirmed receipt of one check but reported they had not received the second.
  February 24, 2023: Complainant reported the second check was still missing. SDC reprocessed the refund and sent it to the complainant.
  February 28, 2023: Complainant confirmed that all expected refunds had been received.

  Customer response

  03/02/2023

  
  Complaint: ********
  
  I am rejecting this response because:
  

  Having poor business operations that makes the company not aware of a complaint (or request to cancel services) for over two months is not a valid excuse or reason for subpar services.

  Additionally, after having received the direct deposit, the cheque that I cashed was cancelled, meaning my credit Union clawed back the direct deposit as well as charged me additional fees for reversing the cheque and taking my account into a negative balance.

  I am now in a net NEGATIVE despite the company’s so-called “reimbursements.”

  
  Sincerely,
  
  ******* ******

  

  Business response

  03/14/2023

  As reported in our initial response, SDC received confirmation from the complainant on February 28, 2023 that all expected refunds had been received. SDC then canceled the second check that was sent since a direct deposit to the complainant’s bank account had been processed to replace it after they reported not receiving it. Unfortunately, the check that was canceled was received by the complainant and attempted to be deposited. In an effort to avoid any further confusion, SDC issued an additional direct deposit to the complainant’s account in an amount that ensured all refunds due as well as any bank fees applied were fully reimbursed. The complainant confirmed receipt of this deposit by email on Tuesday, March 14, 2023. A screenshot of this confirmation is attached.
  
  SDC did not receive notification of the complainant’s initial issue until a few months after it was communicated to their broker. Once the issue was forwarded to SDC, we quickly accommodated the original request and went above and beyond standard processes to resolve the issues created by the delayed communication. We hope the complainant will agree that this issue has been resolved to their satisfaction.

  Customer response

  03/14/2023

  
  Complaint: ********
  
  I am rejecting this response because:
  

  1.) I received one cheque and never received the second. I gave the cheque number of the one I received to ****** ******, meaning the OTHER one should have been cancelled. Why would you cancel the one I received instead of the one I didn’t receive? Do not lie and imply that I purposefully cashed a cheque after saying I never received it  

  2.) When I first requested termination of services, I did so to the Superior Dental Care main office. A ********* then forwarded me to the broker you mentioned. 

  YOU CANNOT BLAME THE TIMELINESS MISTAKE ON THE BROKER *IF* YOUR BUSINESS OPERATIONS PUT THE BROKER RESPONSIBLE FOR HANDLING ISSUES. That is 100% on SDC, and cannot be finger-pointed towards anyone else. 
  

  3.) The fact that it took 4 months, dozens of emails, and a bunch of finger-pointing from **** and ******* and now whomever responds on BBB, signifies that no, SDC did not provide as great of customer service as they’d like to believe.

  I can confirm I have now (finally) been reimbursed. However, I reject every other notion in SDC’s response, and highly encourage any potential customers to avoid this company at all costs. Ineptitude or shadiness prevail.

  Sincerely,
  
  ******* ******

• Initial Complaint

  12/12/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  Superior dental told me '****** ******' that my dental service for a root canal was approved in september, and that i would have a refund check sent to me also in september, it is now going on 3 months and i have never recieved no one check, ********* the call rep has researched my check 3 times now to the point that she remembers me when i call and keeps guaranteeing me that it is on the way but i have spoken to the post office and have been told theirs never been a check dropped off for me and headed my way and that the problem is on superior dental end. I have completly had it with this company at this point, all i want is my check so i can never do buisness with them again. What is the hold up, do we really need to take legal action at this point? After 3 attempts i now want someone with higher authority at this company too assist. Im only giving this one last try then i will have to take it to court. This is the most worst experience ive ever dealt with, and it sucks because i really had faith in superior dental. Either ups my check or fedex it, why are we still sending via a method that is not working? I need answers.

  

  Business response

  12/22/2022

  Superior Dental Care (SDC), shares our member’s frustration with the failed delivery attempts. Here’s a synopsis of SDC’s initial attempts to ensure timely delivery:
  Referenced claim was received on August 15, 2022 and payment was released to the member, to the home address on file (which matches the address shared in this complaint) on September 17, 2022.
  Our member confirmed on October 6, 2022 that the check hadn’t yet been received and asked that his address on file be changed to a preferred address in ******, TX.
  After confirming the check hadn’t cleared the SDC account, a replacement check was released on October 12, 2022 to the revised address.
  Our member confirmed on November 21, 2022 that this check hadn’t been received either. The mailing address was reconfirmed and matched the requested release address. For this re-issued check, SDC had agreed to accommodate release by certified mail.
  After confirming this check also had not cleared SDC’s account, a second re-issued check was released, again to the TX address, on November 30, 2022.
  On receipt of our member’s Better Business Bureau complaint, SDC received confirmation that the second reissued check had not cleared the SDC account; and, that release by certified mail had not been accommodated as had been requested by the member and conveyed in the re-issue submission.
  During a conversation with our member on December 22, 2022, SDC’s Chief Dental Services Officer extended apologies for the unexplainable difficulties being experienced (since both mailing addresses were accurate and none of the issued checks had been returned as undeliverable) and for the failed release of the second reissued check via certified mail. It was also confirmed that a claims payment issued by SDC on July 27, 2022 for a separate date-of-service (for just $45.60) could not be confirmed as received by the member either. SDC will verify the check status and, if uncleared, will include this reimbursement in continuing payment efforts.
  During the call, it was also agreed that SDC would verify the feasibility of electronically depositing the funds, for both prior payments, directly into an account specified by the member. [NOTE: This is not a standard accommodation for member reimbursements.] If feasible, information will be sent to the member via his provided e-mail address to accommodate provision of the information required for processing. If auto-deposit cannot be accommodated, then arrangements will be coordinated with the member for other means of delivery.
  SDC remains committed to timely claims payments and reimbursements. The difficulties associated with these particular payments are highly unusual….but no less frustrating for the member and for SDC. Concerted efforts will continue to achieve payment receipt and resolution. 

  Customer response

  12/30/2022

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. The funds were recieved, and i do believe this was all just an error somewhere with mailing, other than that, i take back my previous statements about the company, they were very fast and helpful with solving the issue, thank you so much!
  
  Sincerely,
  
  ****** ******

• Initial Complaint

  09/13/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Failed to pay an initial orthodontia claim on August 24, 2022, based on exclusions that were not presented at the time of benefit selection. The only exclusion presented to me was pertaining to dependent coverage up to the age of 25. That exclusion did not pertain to me based on the fact that I have no dependents. I Faxed the claim to them, spoke with them approximately Sept 6, 2022, and was told they received the claim but had not been processed yet and requested I call back. I called back this morning, Sept 13, 2022, and was informed that no claim had been filed. Based on the lack of exclusions provided and failing to process and pay the claim based on the information I was given, this constitutes consumer fraud, and the claim should be paid in full.

  

  Business response

  10/14/2022

  Superior Dental Care (SDC) administers self-funded dental benefits for the employer of the complainant. When contracting was initiated, SDC agreed to match the benefits previously administered by another, prior carrier. Those benefits did not include orthodontic treatment for members 19 years of age or older. Pre-enrollment documents provided by the employer include a cautionary statement emphasizing that provided pre-enrollment information was a summary/overview and that it was necessary to refer to “…plan documents for a complete description of coverage, exclusions and limitations”; and, that plan documents determine “eligibility, coverage, exclusions and limitations” if there is any discrepancy with details provided on their website.

  SDC’s records indicate no prior contact with the complainant regarding orthodontic coverage prior to August 24, 2022, which was the same day reflected on an orthodontic transaction/payment receipt which was later provided for benefit consideration.  Earlier that day, the complainant had been required to pay in full for elected orthodontic treatment that the office was aware would not be covered by his dental plan due to his age (greater than the contracted age restriction for the service). Within the same day the Dentist and Member Services Supervisor informed SDC’s Manager of Account Services by email, who then shared it with SDC’s Director of Specialty Product Sales, of the complaint. By August 25^th, this Director had attempted to initiate contact with the employer to immediately inform them of the expressed concern.

  SDC learned that the employer was supportive of the appropriateness of denying the complainant’s request for orthodontic benefits based on the contracted coverage and that this position had been shared by them with the complainant, though likely after the posting of this BBB complaint.

  At the time of the complainant’s contact with SDC on September 13, 2022, his orthodontic claim had not yet been processed and he had initially been inaccurately informed, by a representative who was not familiar with this ongoing issue, that it wasn’t received.

  Once SDC had confirmation of delivery of treatment (orthodontic alignment trays), the received Payment Receipt was processed as a dated claim and a denial of benefits was released to the treating office on September 28, 2022. At the same time, an Explanation of Benefits became available via SDC’s secure, on-line member portal.

  Complying with Predetermination of Benefits processes is the most effective method for ensuring benefit eligibility for costly services. This process was not utilized by the complainant. SDC’s Schedule of Benefits for the complainant’s coverage, a copy of which is attached, was released to the member at the time of enrollment along with an SDC identification card (mid-late December).  The contracted orthodontic benefits and predetermination policy are both detailed on the second page of the schedule.

  SDC has been providing dental benefits for over 35 years and is dedicated to providing the best level of service to our members and clients while ensuring that maximum eligible benefits are provided for covered services. However, based on the accurate representation of contracted coverage and the employer’s agreement, there is no benefit that can be provided for the orthodontic treatment underway.

  Customer response

  10/14/2022

  
  Complaint: ********
  
  I am rejecting this response because:  The plan "coverages" were not presented to me or anyone else who elected benefits.  Hiding the coverages in a link at the bottom of an email when there is an age exclusion listed at the top of their form provided for dependents over the age of 25.  Also, I presented my insurance card, was told I had no coverage by the orthodontia office which I thought was a mistake and made payment in full at the time of service.  I looked at the documents available on my employer website and found no reason for denial of claim and submitted my documents to SDC.  Therefore, not paying the claim constitutes consumer fraud.  I was also not provided with any documentation that states my claim was denied or an EOB as I am still not able to log on to the SDC website that I have mentioned several times to their office.  I also did not appreciate SDC calling and complaining to my benefits manager instead of taking care of this themselves.  That's a juvenile way to handle business complaints.

  As I sit here I'm going to go ahead and assume that SDC will not be paying my claim and take no resposibility with misleading information that was provided at the time benefits were selected.   I've already made my feelings know that I wish to have another company available for dental coverage, which is being denied by my employer. 

  Overall, I would not like to deal with the company ever again.

  
  Sincerely,
  
  ***** *******

  

  Business response

  10/31/2022

  As stated in our original response, pre-enrollment information provided by the employer is intended to provide a high-level overview of the plan options available. As such, a notice is included that states it is necessary to refer to “…plan documents for a complete description of coverage, exclusions and limitations”; and, that plan documents determine “eligibility, coverage, exclusions and limitations”. As explained through direct contact with the complainant and in our initial response to their BBB complaint, the contracted orthodontic benefits and associated age limitation of 19 and younger is clearly specified on the second page of SDC’s Schedule of Benefits for the selected plan. This document was mailed to the complainant with their SDC identification card and is also available to them through SDC’s online member portal, Direct Connect. In addition, and as stated by the complainant in their complaint to the BBB, the dental office performing the orthodontic treatment advised the complainant that the service would not be covered by the dental plan at the time of the visit. Accordingly, a denial of benefits was released to the treating office and an Explanation of Benefits (EOB) was posted to Direct Connect, which is SDC’s standard method of distributing EOBs, on September 28, 2022. To ensure complainant’s access, a mailed copy of the EOB has been released by SDC with the explanation stating that the “Member exceeds the contracted maximum age for orthodontic benefits. Service is the member’s responsibility.”
  
  SDC encourages all members to request a Predetermination of Benefits to ensure benefit eligibility prior to moving forward with treatments and services that could be costly. This is also outlined in our plan documents, including the Schedule of Benefits received by the complainant. Unfortunately, the complainant did not utilize this process.
  
  Because the dental plan in which the complainant is enrolled is self-insured, SDC contacted their employer (the owner of the plan) to provide notification of the complainant’s expressed concern and an explanation of the denial of the claim. The employer supported the actions of SDC and has since been informed of the complainant’s rejection of SDC’s initial response. The appropriate actions have been taken in accordance with the contracted plan, associated documentation provided, and information available to the complainant.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩