• Report: #168824

Complaint Review: Delta Care Dental PMI

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  • Submitted: Wed, December 21, 2005
  • Updated: Wed, April 19, 2006

  • Reported By:Cape Coral Florida
Delta Care Dental PMI
12898 Towne Center Drive Cerritos, California U.S.A.

Delta Care Dental PMI Malpractice Insurance company uses bad dentists who ruin teeth and commit fraud Ripoff Cerritos California

*Consumer Comment: Problems with PMI Dental

*Author of original report: Responding to Comments

*UPDATE EX-employee responds: Not sure but...

*Consumer Suggestion: Mark, You need to file a malpractice lawsuit on each dentist individually

*Consumer Suggestion: Mark, You need to file a malpractice lawsuit on each dentist individually

*Consumer Suggestion: Mark, You need to file a malpractice lawsuit on each dentist individually

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I have had this insurance for many years. This past January I had some pain in my back teeth from clenching. The dentist on my plan, Dental Associates of Cape Coral, did no x-rays but gave me pain medication. This continued for weeks until they gave me a written referral to see Dr. Larry Dunford for work.

Despite the written referral from my plan dentist, this insurance company refuses to cover this cost saying in letters that I did not receive pre-authorization. In the past month, they have tried to change their story that this was not a covered procedure - it was not cosmetic.

This dentist ruined my teeth and resulted in me having to have 2 teeth extracted and a bridge installed. The bridge installed by Dr. Jeffrey Rubin is too large and has ruined my teeth by not allowing my mouth to close and literally fracturing and shattering my top teeth.

Total loss for the past 11 months? $11,000 out of pocket, 10 teeth, and a cost of over $26,000 to repair the damage.

This insurance company has refused to pay for anything. At one point the Florida Department of Insurance was involved at which time the insurance company agreed for me to see an independent dentist for an evaluation of damage. This was the $26,000 evaluation. As soon as the Fl Dept of Insurance dropped the complaint, the insurance company retracted the agreement and said they would pay for nothing.

This past month an article ran in the region's news paper on my situation (see www.news-press.com, columnist - Sam Cook). The School District in which I am employed got involved and they arranged a conference call for a resolution. The insurance company attacked me with claims that I had eroded teeth and that I caused the damage - I countered with proof from dentists that I had no damage to my teeth from erosion or from the clenching. They stated that they only believe dentists in their network.

I have proof that at one point they instructed a dentist on my plan NOT TO SEE ME and not to make any examination of the bridge in question.

They then tried to say I could see any independent dentist AS LONG AS THE DENTIST IS ON THEIR PLAN. They then changed this to include a dentist at the univeristy - IF THEY COULD CONTACT THEM PRIOR TO THE EVALUATION.

This company is a total scam - taking out my insurance payment with each paycheck throughout the year. They and their dentists who have settled many lawsuits and have been found negligent by the State Board of Health, have ruined me financially and with the loss of my healthy teeth.

I have filed many grievances through out this process and they have NEVER found in my favor for anything - ignoring the many evaluations done by many other dentists.

Thank goodness for this format to warn others. Watch for my story on NBC's Dateline!

Mark
Cape Coral, Florida
U.S.A.

This report was posted on Ripoff Report on 12/21/2005 11:02 AM and is a permanent record located here: http://www.ripoffreport.com/r/Delta-Care-Dental-PMI/Cerritos-California-90703/Delta-Care-Dental-PMI-Malpractice-Insurance-company-uses-bad-dentists-who-ruin-teeth-and-c-168824. 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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REBUTTALS & REPLIES:
0Author 6Consumer 0Employee/Owner
Updates & Rebuttals

#1 Consumer Comment

Problems with PMI Dental

AUTHOR: Linda - (U.S.A.)

Hi Mark. We also are having problems with PMI Dental (out of California). I sent a letter to the Insurance Commissioner in Florida and have not yet heard anything back. We intend to send one to the California Insurance Commissioner as well, but I read today that you can filed a claim with the California Department of Managed Health Care http://www.hmohelp.ca.gov We haven't gotten that far yet, but it looks like we're going to. I feel for the people who can't jump through all the hoops. I'm sure that probably pays off for PMI in that most will give up. I bet there are a lot more people with these problems. If I find out anything more I'll write again.
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#2 Author of original report

Responding to Comments

AUTHOR: Mark - (U.S.A.)

Thank you for responding.

To let you know, I have contacted attorneys throughout my area about this situation and NO ONE will take my case. They all say that there are too many individuals involved to be feasible!

If anyone knows of an attorney out there, please have them contact me!!! I am willing to allow the attorney to take a larger percentage than usual just to try to help get some of my financial loss back (as well as my teeth fixed).

Also, Delta Dental is not governed by the State Dept. of Insurance, however when they did get involved it made them take action. However, once the department dropped any investigation, they retracted all agreements made during that time.

I'm so thankful to the Rip-Off Report for letting me know someone is being made aware of what has happened to me!
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#3 UPDATE EX-employee responds

Not sure but...

AUTHOR: Nicole - (U.S.A.)

I am unsure if this is the same company, but if Delta Dental PMI is the same as Delta Dental of California, they are not governed by the Department of Insurance (or whatever its called - sorry its been awhile) in California or any other state. Due to a technicality they ARE NOT technically insurance. However, they are a dental care provider. I worked in claims and they often told us to inform customers who referred to us as "insurance" that we were not insurance. I hope this helps.
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#4 Consumer Suggestion

Mark, You need to file a malpractice lawsuit on each dentist individually

AUTHOR: Steve - (U.S.A.)

..then the malpractice insurance company will go after your insurance company to avoid paying the suit.

Sick them on each other. You will be amazed how fast you get paid when these jerks are looking at several multimillion dollar lawsuits.

Do not let them off the hook!

Get a malpractice attorney immediately!!!!
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#5 Consumer Suggestion

Mark, You need to file a malpractice lawsuit on each dentist individually

AUTHOR: Steve - (U.S.A.)

..then the malpractice insurance company will go after your insurance company to avoid paying the suit.

Sick them on each other. You will be amazed how fast you get paid when these jerks are looking at several multimillion dollar lawsuits.

Do not let them off the hook!

Get a malpractice attorney immediately!!!!
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#6 Consumer Suggestion

Mark, You need to file a malpractice lawsuit on each dentist individually

AUTHOR: Steve - (U.S.A.)

..then the malpractice insurance company will go after your insurance company to avoid paying the suit.

Sick them on each other. You will be amazed how fast you get paid when these jerks are looking at several multimillion dollar lawsuits.

Do not let them off the hook!

Get a malpractice attorney immediately!!!!
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