DentaQuest
Reviews and Complaints

Refusal to cover wisdom teeth extraction causing extreme pain and suffering for a minor.
My contact is [protected]@karas1.com [protected]
DentaQuest Claim/Pre-Auth attached with minor's personal information redacted for privacy purposes.

According to the American Dental Association, wisdom teeth removal may be necessary if you experience changes in the area of those teeth, such as:

Pain

I broke my denture completely in half and was told on 12/272020 by DentaQuest that I did not have coverage for a denture replacement. I called both DentaQuest and Wellcare about the miss information pointing out my policy stated that I did have full coverage. After numerous phone calls back and forth to both DentaQuest and Wellcare. I went ahead and had a denture made out of network and paid in full out of pocket $725.00 on 1/12/2021. On 1/15/2021 DentaQuest finally called to tell me that I did have coverage and since I went out of network I would have to fill out a reimbursement form and that it would take up to 6 months for payment. I filled out the reimbursement form and sent it to Wellcare which they received in 2/2021. Wellcare sent me a letter in 4/2021 stating that the reimbursement form was forwarded to Dentaquest. I waited till 6/2021 since that is I was told by Dentaquest in 1/2021 that it would take at least 6 months for my reimbursement. Dentaquest stated that they never received the form from Wellcare. After numerous phone calls again in 6/2021 and 7/2021 I was told by both Dentaquest and Wellcare that since I went out of network the claim was denied. I would not have gone out of network if they would have told the truth to begin with about my coverage. I am asking for full reimbursement since they are the one that misinformed me about the policy. Dentaquest also stated that they do not reimburse any out of network but Wellcare states that they do. As of 7/2021 Wellcare is now stating that it is up to Dentaquest and has sent me another reimbursement form to fill out. It seems as if both companies do not want to honor what the policy states. I must assume that I am not the only policy holder that has problems with both of these companies.

I have a literal rotting impacted wisdom tooth that needs removed and they denied me on some nonsense reason saying the route isn't fully formed like it's rotting in my mouth. switching my insurance provider for sure this is enough they deny everything! Seriously they will say "their dentist" reviewed you were requested dental service and deemed it medically necessary it doesn't matter if it is causing you health issues or not apparently because they have some mystery dentist there to deny everything. Crooks!

I am being under this dental quest plan for quite some time and have not got the proper dental service in addition, I being complaining I being complaining about my coverage them giving them listings that are not in network and have being able to assist me moreover, I being telling these people that I have being able to get treated for dental service. Since I being with plan I have not satisfied with the proper help and being addressing this for months and nothing has being done for the most part, I have yet to get my teeth looked at.

I called around June 5th, I was told when I called, that since I had no where else to go, that I would be reimbursed the full 100%, $165.00. I was only sent $19.00.

I would not have went, if it wasn't going to covered, that's why I called to begin with.

This was a consultation with North Fulton Endodontics,

Member # [protected]
Sandra Markley
678.350.8943

On Thursday June 3rd and Friday June 4th I an appointment with Elida Dental Care 94-38 59th or 94-49 59th street [protected]
in Elmhurst Queens 11373 for a Albicol? or a root canal done.

They charged me for a CT Scan $350 out of pocket. of course its not included in my dental benefits but Dentaquest still denied me of getting the service. I had to put in reimbursement for my money back and I had to email the state on their conduct. They are rude and unprofessional. I am making a complaint about Denta quest is always denying services and I am walking around with a infection until Brookdale Dental will do the procedure next week. The good thing is I have antibiotics.
I do have documentation, and my receipt for $350.

I had tooth #30 extracted due to a fracture which had formed a large abscess. The dentist files a pre-authorization for a bridge which my plan does cover. The bridge was denied but the core buildup on #29 and #31 were approved which is absurd because if I weren't getting a bridge those 2 teeth would not need work. I called DentaQuest to find out why this was denied and to file an appeal on 03/19/21. I was told to check back on T, 03/23 but I waited until 03/24/21. when I called the member # [protected] I listed to the prompts and it said claim [protected] was approved and listed 2950 #29 approved, 6740 #29 approved, 6245 #30 approved, 2950 #31 approved, 6740 #31 approved. I then spoke to a representative to confirm this and to know my portion which I was told would be $410.75. I then called my dentist to schedule the work which was done on 03/30. The office had not received the pre authorization so on 03/31 I called denta quest to have them send over the authorization and was told there wasn't one. I explained I just called yesterday and was told the preauthorization was accepted and they even told me what I was responsible for. When I check the automated phone it tells me it was accepted and list all 5 codes. Now I had the work done because someone there told me everything was fine and you are now saying there no pre-authorization on file and no record of me speaking to anyone on 03/24. I have literally called everyday since then. the same approved message is on the automated machine I have temporary crowns in my mouth and now I am not sure if or when this will get approved. This is a real mess and has caused me anxiety when it shouldn't have. someone did not do their job and it causing me problems. this needs resolved.

I was with DentaQuest/Trust for all of 2020. I did not use this service during the year because of Covid.
I was able to get a job for the last few weeks in 2020 and was offered benefits, for which I enrolled. The job did not workout so I went back to the marketplace and bought health and dental insurance (DentaTrust, again).
During December of 2020 my jaw began hurting severely along with my neck, shoulder, arm, and hand. After I stopped using that hand for a few days the pain subsided. I had an episode of this in January of 2021. But the arm and hand pain have not come back, but my jaw was hurting everyday - and still is - and getting worse! (up to a 10 at times)
My pain management doctor wanted to schedule an MRI of my neck (I have degenerative disc disease). I also consulted with a primary care physician and he was concerned that it may be cardio related and wanted to schedule a stress-test.
A friend mentioned that it might be a tooth that was infected, although none of my teeth or gums were hurting. I decided to see a dentist before I had those other tests.
The dentist took x-rays and discovered that there was indeed a severe infection under the very last, bottom molar. She gave me a prescription of antibiotics which a started taking immediately.
She recommended an oral surgeon to do a root canal and then she would put in a crown. I could not have afforded any of those procedures even with the help of insurance. So I asked if I could just have it pulled and she said yes, but would still have to have an oral surgeon pull it out.
DentaTrust has a waiting period of six months before restorative procedures will be covered.
(First-of-all) I thought no problem because tooth extraction was not "restorative".
I called DentaTrust to get help with this and was told in a very, cold, unwavering voice that I would still have to wait. I asked about the fact that I had an infection going on and learned that DentaTrust did not care - the waiting period had to be enforced. I asked to speak to her supervisor and was told that the supervisor can't change the waiting period!
I started to get scared and did not know where to turn. So I called DentaTrust back to get a different representative, which I did...
(Second-of-all) this different rep told me that because I had DentaTrust all last year that the waiting period had been met... then a pause and "oh" she said, "you were not enrolled for the month of January so the waiting period did have to start over." I was in tears, and am still in so much pain. I looked up online to see if the ED (ER) would be able to help and it doesn't look like it could do anything else, I'm already on antibiotics.
In looking at options, I came across this complaint board. Even though I am still getting no relief from the pain, I learned that I am not alone in this.
I called the member services number and had a great experience. Although I learned that the only two oral surgeons that took DentaTrust insurance were more than 30 minutes away. I live in a huge city, in fact in the midst of two cities... only two practices use this insurance for oral surgery.
How does this happen? I can not understand how an insurance company can take your premium payment every month but not provide coverage.
I have this infection and terrible pain and have no one to help.

My wife had a cavity filled, and the bill was for $210.00 Dentaquest paid only $4 of this bill, saying that there was a cheaper way to do it for only $5. Nothing can be done at the dentist for only $5.00
And we purchased their best plan, which should have covered 80% of this procedure. And on her visit before this, they paid nothing on an emergency dental visit for a cracked tooth. They claimed that was a routine maintenance procedure, and because we already had a cleaning done, they could not pay any more on routine maintenance for 6 months. That one cost us $68.00!

Dental quest is horrible they deny almost all dentist requests for patients. Its a medicaid dental plan that does nothing to help the patients get what they need and dentists don't even want to participate with them. When you call for a dentist all they give you is information of providing dentists that don't even participate with denta quest. Medicaid needs to get a better plan this is horrible. I been due for a cleaning since may 2020 its now aug 2020 and im unable to find a dentist in my area denta quest tried to send me to ny city I live way far away from ny city medicaid needs more dentists that accept denta quest in my area all they dentists they send you to do awful work and don't send the bill correctly to denta quest or denta quest just gives them a hard time so the dentists shy away from them its awful my teeth hurt and I need a dentist

[protected] Group number: [protected] DentaQuest
I signed up for this insurance through the marketplace.gov for pediatric high option which was to cost 49.98 according to the marketplace. Received no info in the mail but called to receive billing info to pay premium which I was then tol would be 66.64. I chose a dentist from the dentaquest website based on my plan and verified with them prior to the visit (Jan 3 evening) that my insurance information was correct and verified. (Children's Dental health of Downingtown, 19335)Time of visit (Jan 6, 2pm) (with a very nervous 7 y.o. taken out of school for the dental work) I was told insurance wasn't in and I would have to pay $220 for the visit or they wouldn't be able to work on my son. I did so, assuming it would be worked out with the insurance. Now I am told by the dental office that they terminated their contract with that insurance in 2018. DentaQuest representatives have taken my information and told me they would call me back multiple times without ever providing an answer as to whether they have a contract with said dental practice or not. Practice says they can't bill due to no contract. Insurance premium paid. Dental bill Paid - more bills coming. No dentist for ongoing needed work for my kids. attached is the dentaquest website dentist search tool and results which I used to chose the Children's Dental Health, 19335 for my children's care.

https://govservices.dentaquest.com

Please contact me at [protected] to help me navigate this time consuming issue. thank you,
Laurie Taylor

For anyone even thinking of Emblem consider this. They have denied a doctors request for an MRA for my 43% blockage and will only approve it when it gets to 70% blockage.
Then I needed a dentist so they "researched the Latest listings" and came up with 3 dentists who nearly dropped the phone when I said I had Emblem . Then I complained about them giving me such a lousy choice and they actually got a conference call going and a Supervisor for their partner in crime Denta Quest said she would get to the bottom of this and did more research and came up with, get this, sending me to the kids practicing on humans at Stonybrook and yet Another dentist who won't take Emblem or Denta Quest . They searched over 100 miles on long island and came up with nothing but lots and lots of emails, phone calls, and not a single oral surgeon in all of Suffolk County. I am not saying the other companies are any better but this is my experience with Emblem.

My daughter was given a referral from her dentist to have her wisdom teeth out. The surgeon sent her xrays and a report to DQ stating she was having headaches, intensive pain, not eating well, under pain medication for over a month and she took antibiotics for the infection, and all 4 teeth were impacted. DQ denied the upper teeth and only approved the lowers. My daughter is being in pain for over a month now. I have appealed the decision and filed a grievance but the receptionist said they do this to Kids all the time. And every time I call DQ say since there's no infection is not medically necessary. They failed to see that she already took antibiotics to prevent the infection to spread. My daughter will get the lowers taken out next week and probably not be able to do the uppers until much later because we don't have the money to prevent her going through this procedure twice. DQ claim that the board reviewing the claims are all dentists but I wonder if that is true because On their website it says that "insurance consultants" make the determination based on submittal of the dental climate form and they can't really say if is medically necessary or not because they do what's on the script for them. Now I have to either come up with over a thousand dollars or wait until my daughter's teeth gets infected or inflamed to get them removed. Just not fair.

As a provider I have been on hold waiting to talk to someone for an hour and a half. We are not even a provider with dentaquest anymore (for this reason exactly). A patient of ours was incorrectly directed towards our office claiming we are a provider with them (even though the automated system even knows we are not). I am just simply trying to help a person with this very very bad insurance find a dentist they can go to... An hour and a half and still not a single human has spoken.

Wow! I'm a single mother with a special needs teenager and after reading everyone's heartache in dealing with this company is it worth requesting a review? Its FL Medicaid? He has TMJ migraines grinds teeth crowding over/underbite speech issues mouth pain and DQ Ins rejects claim. Saying "Our dentist looked at the information sent" Hmm I question that statement.

My son has crowded and impacted teeth and my dentist agreed he needed braces and gave us a referral to an orthodontist. The orthodontist agreed he needed braces and said they highly doubt I would be denied since he has impacted teeth. Well, Dentaquest denied us. We went back to the dentist a few months later and he couldn't believe we were denied and gave us another referral to a second orthodontist. This orthodontist could not believe he was denied and agreed it was medically necessary for braces. He said there was absolutely no way they could get "21 points" when he clearly had "28 points" (26 points are required to be approved). Dentaquest denied us again. This insurance is such a SCAM. Something needs to be done! There is NO reason kids (and adults) should have to suffer because they don't want to pay!

They denied deep tissue cleaning. The dentist told me to resubmit the claim "because Dentaquest often lies." I printed out Dentaquest's guidelines for covering this procedure and brought it back to the dentist this morning. The dentist showed me the claim they submitted and it matched exactly with dentaquest's guidlines yet they still denied it. What they're doing is illegal and immoral but I guess they don't think patients will do the research, because they just made it very easy to take legal action.

When tell I've never been so pissed off I've emailed Steven Polluck the CEO of this company to think the issue would be resolved about continued car for my son and braces and now he has devolved and infection and has been hospitalized and now being treated for an infection that hopefully doesn't spread through his body. No supervisors call you back and I've been waiting months I'm highly pissed off.