- Report: #1071814
Report - Rebuttal - Arbitrate
Complaint Review: 1199
1199330 West 4nd Street NY, New York USA
1199 REFUSING TO APPROVAL DENTAL CLAIM FOR OVER FOUR MONTHS NY NY
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On 24 April 2012, I went to the Dentist, who determined I needed a deep cleaning of my lower jaw, and a replacement crown. 1199 dictates that all claims be mailed. The only reason 1199 demands that claims be mailed is so that they can blame the United States Post Office for slow or no delivery. There is zero record of any mailings, so 1199 has zero accountability. My claim was mailed on 25 April 2013. On June 26, 2013, a complete denial of all services was received by my Dentist asking for credentialing information, and asking he re-file the claim. That is a total of two months. Very slow and then no. All credentialing information was mailed, along with a refiling of the claim.
On 30 July 2013, I called 1199, I was informed that a partial denial was mailed on 16 July 2013, along was a request for another copy of my X-Rays, as "something is not clear". As of today, my Dentist has NOT received a copy of this partial denial. I was further informed that if I walked the X-Rays in, a decision "could" be made in 7 or 10 or 15 business days. That would be 4 full months of denial. The X-Rays are perfectly readable. The X-Rays are unclear to 1199 because this is a tactic used by 1199 to deny services. My teeth need to be cleaned, my crown needs to be replaced. Teeth that have a built up of tartar leads to heart disease, especially in the elderly.
At 63, I am elderly. 1199 offers a $375.00 upper body scan of the heart, lungs, etc. I took the scan, on a scale of 0-3000, I scored zero, for zero plaque in my heart arteries. After waiting 4 months for approval for needed dental care, I wonder what my heart arteries look like now. No other entity collecting fees, (my mandatory unions) would be allowed to deny services on this level. The union is a business providing services of which it is mandatory that I paid. My dues are collected from my check just like taxes, yet I receive zero services. I was denied medical benefits for two full months. My benefits did not start until December. 1199 never received the form. The form was completed and handed in when I completed the form for the mandatory union dues.
The form was completed twice more. Our medical benefits are supposed to start 90 days after employment. I saw the Eye Doctor in March, I received the acknowledgment of payment by 1199 to the provider today. This provider is in network. That is almost five full months after service. Many of my co-workers have also suffered denial of services. CB - a young adult female aged 25, a Juvenile Diabetic, denied total medical benefits for six full months despite working full time, and paying union dues. TH - has a 12 year old daughter, whose braces are about to come off, not one payment for services have been rendered to the Dentist providing the care for over a year. CJ - attempting to get information on his pension status, worked 6 full years at another 1199 hospital, 17 years at BI, 1199 has no record of the 6 full years at the previous hospital.
MN - has a wife who worked for 1199 fifteen years ago. MN works at BI, and has received services for his son up until three years ago when suddenly 1199 stared denying services stating the wife no longer works for them. 1199 has stated this is a glitch in their system. This glitch has been going on now for three full years. This nurse was visit 1199 for each claim. 1199 flat out refuses to fix the glitch. PT - a patient at the hospital, has had her birthday incorrectly listed for five full years, 1199 flat out refuses to correct this. This is a retiree. Under any other circumstances 1199 would be convicted as a thief. My Dental benefits must be released so that I can get the care immediately. If you cannot help me please refer me to someone who can. Thank you
This report was posted on Ripoff Report on 07/31/2013 01:31 PM and is a permanent record located here: http://www.ripoffreport.com/r/1199/NY-New-York-10036/1199-REFUSING-TO-APPROVAL-DENTAL-CLAIM-FOR-OVER-FOUR-MONTHS-NY-NY-1071814. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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