DentaQuest review: Dental insurance

Hi

Since February 2023 I been trying to find an Endodontist to do a root canal on a tooth that had infection. I checked on Healthfirst and Dentaquest (handling the dental for Healthfirst) website to locate an Endodontist. There were only 2 Endodontists in the 50 miles radius around my home in the NY area which they were in hospitals and was impossible to reach them. I called Healthfirst and Dentaquest multiple times for help locating an Endodontist in which for hours I was on the phone with them and they tried calling these 2 Endodontists in the hospital which was unsuccessful. They then escalated the case to a team to try finding a regular dentist to preform the work. While waiting for the team for weeks trying, I called every single dentist on their website to see if any of them does root canals.

I realized 60% of the dentists listed on their website do not even take this insurance, the other 40% tried very hard giving me an appointment but I will have to pay for the visit and after the evaluation they would try to locate an Endodontist for me.

I went to few of these dentists and they all told me I need to do a root canal asap before this spreads but they dont do it. After weeks of back and forth with Healthfirst and Dentaquest trying to locate a dentist that can perform the work they said they were unable to find one. I went to another in network dentist that stated on their website they do root canals and take my insurance. After taking x-rays I was notified that the infection was now in multiple locations even with taking very strong antibiotics 3 times in 3 months while waiting to locate a dentist but the dentist does not do root canals in my case and I need an Endodontist.

I called again Healthfirst and Dentaquest and been bounced around from Healthfirst to Dentaquest for few more weeks with no success. At one point I was able to find a regular in network dentist that said they will do the root canal. I went to this dentist and started doing root canal on tooth #4, after 2 1/2 hours when she finished the root canal she said I think you should pull this tooth and put an implant. I said why? She said you dont have enough tooth to support a crown and it will fall after 2-3 weeks. I said what about the other 3 teeth that need root canal? She said we do root canal on them and most probably after the root canal you will need to pull them as well. At this point I knew I was being scammed. I asked to fill up the tooth and I will check with another doctor. I was also charged about $800 that I had to pay as they said there is an out of pocket limit that I need to meet before the insurance starts paying.

I went to an Periodontist in the same company to see if the tooth can be saved, the Periodontist said, of course you dont need to pull none of them and they all can be prepared for a crown. I went to 4 other out of network dentists for opinions and they all said you dont need to pull the teeth or shave any bones and they all can get a crown with no issue. They also said that the dentist that did the root canal did not do a good job and it needs to be redone.

At this point I called Healthfirst to put a complain and help to find a resolution. They suggested to put a grievance and Appeal to get me to an out of network dentist. After 3 grievance and appeals on July 12, August 1 and August 7 that were denied I was able to speak to a supervisor Nicole K on August 11, 2023 which she said the Grievance and Appeals that were submitted were not submitted correctly and she submitted another Grievance and Appeal #[protected]. On August 31, 2023 I got the approval on Attorization #[protected]. I also received a letter from healthfirst stating $26,025 was approved with the out of network dentist.

At this point I called the dentist and made an appointment to start the work, the dentist office said they need to get a list of guaranteed payments for the work being done before they start the work. The dental office was not able to get a solid answer from Healthfirst or Dentaquest so I called them on September 12 and spoke to Michel from Healthfirst which talked to Nicole from Dentaquest, Nicole called the provider office and transferred us to Provider Services. We talked to Rita at provider services from Dentaquest with Sajma from the dental office on the phone which I explained to them the provider needs to know the exact money they are getting for each dental code before they take me in and start the work. After lots of going from system to system she came back with a list of all the payments that will be paid in full to the out of network dentist which I will attach if there is an option here. She also said according to one of her systems since the dentist is out of network there will be no coinsurance due on my part and if the dentist was in network then I would have to pay the 20% coinsurance. I and Sajma from the dental office confirmed this 3 times with Rita to be sure there will be no misunderstanding and she did confirm this with us over the phone 3 times that all the amounts in full will be paid to the dentist.

So I started the work with the dentist since we were sure it will be fully covered. The dentist started sending the bills to Dentaquest and they kept getting denied. I called Healthfirst and Dentaquest and Dentaquest said that I was correct and they will have to send it back for payments as the bills go through a computer and since the dentist is out of network they will get denied automatically.

November 13, 2023 the doctor said they received only $1,031 out of the bill of $8,100 for teeth #4 and #12. November 14, 2023 I called Healthfirst and Jennifer put Kisha from Dentaquest on the line which connected us to Jesus and they denied the payments. Then Jennifer called again and connected Christin a supervisor from Dentaquest that is very familiar with all the trouble I went through since February and said she will put an Appeal and a request to check on the call from September 12 with Rita (reference for call #[protected]) and the provider on the phone. Reference number for dentaquest is #[protected]. Also Jennifer put another Appeal with Healthfirst for only 3 of the bills that came in. Date of service 10/16/2023 Ref#[protected], Date of service 10/5/2023 Ref#[protected] and Date of service Ref#[protected]. I keep calling every day and so far they either deny the full payments or they say there is no answer yet.

This is a short list of calls and time I spent trying to get the work done on my teeth and after approved paying this bills they started playing games. Now I am stock with $25,000 bill that the dentist want me to pay which I cant afford. I am paying about $1,800 a month for this insurance which they send me cancellation letters if late paying 1 day but they are not standing by paying for what they need to cover.