Called Delta and spoke with Tony he said that he had records of my calls and that on 11-23-10 I spoke with a Fernando Rodrigues not Sheldrick and that he told me that the pt had 648.00 remaining and gave my frequency hx. He said on 12-15-10 I spoke with Michael Hunt not David and he gave me remaining max and hx of fmx on 1-4-11. I explained to ” Tony ” that I did not make up these names and  information they gave me. They never gave me a hx of fmx. He documented our conversation read a recap back to me and said he would forward this information. I also explained to him that the patient states he did not go to the dentist on 1-4-11.  I relayed this information to patient he said that Delta gave him an address **** Geary St in San Francisco for the dentist that was paid and that they could not give him the name. He said that he was going to call the dentist they could not give him the name

9-1-11

dos 8-4-11 Spoke with level II rep Shauna at Delta she said that they had no claims on file at all for secondary. I gave her dos 7-27-11, 8-4-11, 8-18-11 she pulled up the primary claim and said that all the information on the claims we sent was correct. ” You did everything all right and we did everything all wrong ” She said secondary was in old system and primary was in new system and they weren’t linked. She sent claims for reprocessing for secondary and she said to give them about a week and a half to process AG

9-22-11

os 9-1-11 Spoke with level II rep Tracy 3:20 no claim on file for secondary. She reviewed primary claim and said that she would have secondary processed immediately AG

11-2-11

dos 8-4-11 8-18-11 Called Delta 10:30 Spoke with Erica 10:49 she said we have the claims I`m not sure why they were not processed. I explained to her that I had called on 9-1-11 and told that they would be sent for reprocessing. She said she would have to transfer me to someone who could help me. Transferred at 11:03 Spoke with Mark at 11:21 He said they have the claims and that the reason that the secondary wasnt processed was because there was no group # just a bunch of zeros. I relayed my conversation with Shauna that she said everything was correct on the claims. He said ” I don`t know what she saw but she was right that the primary claims were in the new system and the secondary was in the old system I know exactly what to do I will send these claims back for reprocessing. It will take 2-3 weeks.” Call ended 11:28 tasked myself to f/u 1 weekAG

11-9-11

dos 8-4-11, 8-18-11 Called Delta spoke with Shay 2:25 she said claims no claims were on file or being processed gave her primary info she saw claims and I explained that I had been calling since 9-1-11. She said that she saw the other notes and that all the reps I spoke with before were in CA and that all she could do was to transfer me to a level II rep there in TX. Transferred to John 2:35 gave him all info all over again even had to hippa verify again. He said there were no claims on file for the secondary. I asked him since I had been calling all these months do we get to collect interest? He said we do not get to collect interest. He said ” I am making a note that you have called several times and nothing was ever done. I`m just telling you that as a level II rep I am sending it back for reprocessing ” I told him that all the other reps that I spoke with previously were level II reps and I wanted it noted that all these months Delta Dental had been collecting interest on the monies owed to us and that I didn`t think it was appropriate because they had obviously had the claim on file all this time. Call ended 2:50 Tasked myself to f/u 1 week AG

11-16-11

dos 8-4-11, 8-18-11 Called Delta spoke with Atencia 11:03 claims were not on file. She said she would transfer me to level II rep with all the notes that I have called several times. Transferred to Kathy 11:16 She said she would print out claims which should have been done in the first place and send them back for reprocessing. I asked about interest on the claims since Delta had obviously had the claims since before my 1st call on Sept 1. She said that Delta would automatically pay interest on any claim that they had record of over 30 days. She said that she was going to transfer me to a supervisor who could expedite the claim. She put me on hold until 11:38 she came back on and said that she could not wait on hold for a supervisor any longer and she was just going to put back at the end of the line. I told her I would hold and that I was on hold for an hour last week. She refused to let me stay on hold for a supervisor she said she was going to print the claims and email them to her supervisor and she was going to keep a copy for herself so that she could make sure it was taken care of. I asked her to please fax me a copy so that I would have a record from Delta in the patient chart. She said she could not fax me anything but she gave me her agent # . She said she would have her supervisor call me. I told her I wanted a return call today because no supervisors ever return my calls. For example I have left 2 messages recently for supervisor Laura xxxxx with no return call. She said she didn`t know if she would call today but I should get a call by tomorrow. Call ended 11:42 Tasked myself to f/u 1 week AG

Called pt left message that August claims have not paid and that there is a balance. Asked him to please call me so that we could discuss ins and balance AG

Pt called back I explained to him that Delta has the claims with all the correct info ie group #, ID # there is just no follow thru with processing. He said he was going to call Delta and I advised him to speak with a supervisor AG

Pt called said that he had called Delta and they told him that they had the claims but they had been rejected because the information was not accurate. He was told that they are not in process because it was a ” legal thing ” and that they were not going to reprocess claim because it had been rejected. I told pt I would email him claims that shows accurate info and we would f/u in a week because I was waiting for a supervisor to call me. Emailed pt claims. AG

Hi ……,

I have attached a copy of the claims so that you can see all the information is complete and accurate. I was told by Delta rep Kathy agent #…. today at 11:38 a.m. that she would have her supervisor call me to expedite these claims. I have NEVER had a Delta supervisor return my calls so I am sceptical that it will happen. I will contact Delta again in about a week or so if I don’t hear from them. I anticipate that Delta will eventually process the claims. I just wanted you to be aware of the situation and that Delta has a problem with their processing systems. Please call me if you have any questions.

Have a good evening and if I don’t speak with you before hand I hope you have a very Happy Thanksgiving!!

Angela

11-17-11

dos 8-4-111, 8-18-11 Called Delta spoke with Laura

(not the supervisor )11:15 she said they did not have the claims on file. She found primary claims and continued to tell me that they didnt have claims for secondary. I asked to speak with a supervisor was transferred to Cynthia 11:27 she said she didn’t have claims on file either I gave her primary info and she asked my for some background. I explained all my previous contacts and that I did not get a return call yesterday from a supervisor. She was very apologetic and said ” I have sent the claims to be expedited that is what I was doing while we were speaking. They should be processed and paid by next Wednesday but because of the holiday you wont receive the check until the week after. I am a supervisor. ” She gave me her # (xxx) xxx-xxxx and also her email xxx.xxxx@delta.org. She said it may be easier to contact her by email. Tasked myself to f/u 2 weeks AG

11-28-11

dos 8-4-11, 8-18-11 Called Delta to see if they had claims on file spoke with Elda 12-:49 then transferred to Level II rep Jan 12:51 she said they didn`t have claims on file. She asked if I had checked my clearing house. I explained to her all my previous conversations highlighting my last one with Cynthia. She put me on hold came back said she found the claims and that she knew what the problem was that the secondary was in the old system and the primary was in the new system. She said that as of this weekend there is only one system and that everything had been transferred to medivan. She said she was sending it for reprocessing. She said I had spoken to reps in CA before but she was in PA I told her that is what every rep had told me previously even the ones in TX. She said she didn`t know why I would have spoken with anyone in TX because there were no reps in TX. She said that once the claims were sent back by the reps that they have no control over them and that ” they disappear from their individual systems ” She put me on hold and spoke with her supervisor Jeremy she said that he was sending it back through and it should be in the system within 48 hours. She said she would call me back by Friday. Call ended 1:12 Tasked myself to f/u Friday 12-2-11 AG

As of today 12-7-11 claims for dos 8-4-11 and 8-18-11 have yet to be processed and paid. Is anyone of these representatives held accountable for there lack of action? No! And that is why I think they are trying to drive me crazy!!!

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