UnitedHealthcare Dental

CHIP Complaints

You have the right to file a complaint at any time. Please call Member Services and we will address your questions or concerns about benefits, services, access to appointments, wrong bills you received or other issues. If possible, we will resolve your problem at the time of your call. If that is not possible, we will ask for more information and get back to you within 30 calendar days after your complaint is filed. At any time, we may ask you for more information.

You can also file a complaint in writing. An authorized representative - someone you choose in writing - can help you. Your authorized representative can be a friend, neighbor, family member, provider or attorney.

Complaint Process.

What should I do if I have a complaint?

We want to help. If you have a complaint, please call us at 1-877-901-7321, TDD/TTY: 7-1-1 (toll-free) to tell us about your problem. A UnitedHealthcare Dental Member Services advocate can help you file a complaint. Most of the time, we can help you right away or within a few days at the most. To get status of a complaint, contact us at 1-877-901-7321, TDD/TTY: 7-1-1 (toll-free).

If you still have a complaint after you’ve gone through the UnitedHealthcare Dental ’s complaint process, call the Texas Department of Insurance at 1-800-252-3439 (toll-free). If you want to make your complaint in writing, please send it to the following address:

Texas Department of Insurance
P.O. Box 149091
Austin, Texas 78714-9091

Who do I call?

We want to help. If you have a Complaint, please call us toll-free at 1-877-901-7321, TDD/TTY: 7-1-1 to tell us about your problem.Send written complaints to:

UnitedHealthcare Dental Texas CHIP
Appeals/Complaints Department
P.O. Box 1427
Milwaukee, WI 53201

Can someone from UnitedHealthcare Dental help me file a complaint?

A UnitedHealthcare Dental Member Services advocate can help you file a complaint. Just call 1-877-901-7321, TDD/TTY: 7-1-1.

What do I need to do to file a complaint and how long will the process take?

Please call us at 1-877-901-7321, TDD/TTY: 7-1-1 (toll-free) to tell us about your problem. A UnitedHealthcare Dental Member Services advocate can help you file a complaint. Or you can write to us at the address below. Most of the time, we can help you right away or within a few days at the most. Send written complaints to:

UnitedHealthcare Dental Texas CHIP
Appeals/Complaints Department
P.O. Box 1427
Milwaukee, WI 53201

We will send you an acknowledgment letter less than 5 business days after we receive your complaint. The letter will also tell you what you can do if you still have concerns.

We will review your case and send you a letter with our decision within 30 days from the date of your complaint.

If I don’t like what happens with my complaint, who else can I call?

If you still have a complaint after you’ve gone through the UnitedHealthcare Dental’s complaint process, you can call the Texas Department of Insurance at 1-800-252-3439 (toll-free).

How can I file a complaint with the Texas Department of Insurance after I have gone through the UnitedHealthcare Dental complaint process?

If you still have a complaint after you’ve gone through the UnitedHealthcare Dental ‘s complaint process, call the Texas Department of Insurance at 1-800-252-3439 (toll-free). If you want to make your complaint in writing, please send it to the following address:

Texas Department of Insurance
P.O. Box 149091
Austin, TX 78714

CHIP Appeals

An appeal is a request to change a decision made by UnitedHealthcare Dental for medical care, services that you or your provider believe you are entitled to receive. You, or an authorized representative, can file an appeal in writing, in person, or by calling UnitedHealthcare Dental Texas CHIP Member Services. Requests to review services that were denied by UnitedHealthcare Dental Texas CHIP must be made within 60 calendar days of UnitedHealthcare Dental Texas CHIP decision to deny a service or supply. We will review the care or services that were denied or the coverage decision that was made. Send written appeals to:

UnitedHealthcare Dental Texas CHIP
Attn: Grievance and Appeals Unit
P.O. Box 1427
Milwaukee, WI 53201

You have the right to:

Ask for and get copies of all documents related to the appeal. You may add information about the appeal to your file in writing or in person. Continue to have CHIP covered services while your appeal is under review. To have these CHIP covered services continue, you must call or tell UnitedHealthcare Dental Texas CHIP within 10 calendar days of being notified. If the appeal is denied, you may be responsible for the cost of any continued benefits you received. If the appeal is approved and you did not request that your services be continued while your appeal was pending, UnitedHealthcare Dental Texas CHIP will authorize or provide services within 72 hours.

Qualified UnitedHealthcare Dental Texas CHIP staff decide on appeals that are not about medical issues. Qualified health care professionals decide on appeals about medical issues. We will make a fair decision about appeals within 30 calendar days of receiving your appeal.

Can someone else appeal for me?

Yes. Your doctor, another provider, or anyone you choose can ask for an appeal.

Appeal Process

 

What can I do if UnitedHealthcare Dental denies or limits a service for my child that the dentist has asked for?

If you do not agree with the UnitedHealthcare Dental denial, you have the right to appeal. You can ask UnitedHealthcare Dental to help you file an appeal. You can also choose a provider, a relative, a friend, or lawyer to appeal on your behalf. The person you choose must have your written approval to appeal on your behalf.

How will I find out if services for my child are denied?

You will receive notification of a denial for service(s) requested for your child in the mail. You can call Member Services at 1-877-901-7321, TDD/TTY: 7-1-1 for a status on a request for services for your child or view the status on the member website. Your dentist may also tell you about the denial.

Expedited Dental Plan Appeal

 

What are the timeframes for the appeal process?

You must ask for an appeal within 60 days from the date you get our denial letter. If you want UnitedHealthcare Dental to look at your case, you can ask for it by writing or by calling us. If you, or the person you choose to appeal for you call Member Services to ask for an appeal, Member Services will put your appeal in writing and send it to you to sign. You, or the person you choose to appeal for you must sign the appeal and send it back to us, unless you have requested a fast (expedited) appeal.

You can request an extension of up to 14 calendar days if needed. If UnitedHealthcare Dental determines there is need for more information or an extension is in your child’s best interest, we will notify you in writing. We will state how a delay is in your child’s best interest.

When can I ask for an appeal?

You must ask for an appeal within 60 days from the date you get our denial letter. Your services may continue while your appeal is being looked at, if all of the following apply:

  • You ask for an appeal:
  • Within 10 calendar days from the date we mailed the denial letter, or
  • Before the effective date of this denial letter.
  • The appeal request is related to reduced or suspended services or to services that were previously authorized for you.
  • The services were ordered by an authorized provider.
  • The authorization period for the services has not ended.
  • You asked that the service continue.

You can also ask for an appeal for partial or complete denial of payment for services. You can request an extension of up to 14 calendar days if needed. If UnitedHealthcare Dental determines there is need for more information or an extension is in your child’s best interest, we will notify you in writing. We will state how a delay is in your child’s best interest.

Can I just ask for an appeal or does it have to be in writing?

You can ask for an appeal in writing, or you can call and ask UnitedHealthcare Dental for an appeal. We will send you a one-page appeal form that you, your child’s dentist, or someone else representing you can fill out and return to us.

Can someone from UnitedHealthcare Dental help me file an appeal?

Yes. Please call Member Services at 1-877-901-7321, TDD/TTY: 7-1-1 to ask for an appeal. A member advocate will put your appeal in writing and send it to you to sign.

Expedited Dental Plan Appeal

 

What is an expedited appeal?

Ask for an expedited appeal when you don’t have time for a standard appeal — when your child’s life or health is in danger. When you ask for an expedited appeal, UnitedHealthcare Dental has to make a decision quickly based on the condition of your child’s health.

How do I ask for an expedited appeal?

You can ask for an appeal by writing or calling us. You, or the person you choose to appeal for you can call Member Services to ask for an expedited appeal.

How long does an expedited appeal take?

We will review and respond to your expedited appeal request within 72 hours.

What happens if UnitedHealthcare Dental says it won’t give me an expedited appeal?

If UnitedHealthcare Dental does not think delay in care is life threatening, we will notify you within 72 hours. Your appeal will be processed through the standard appeal process. We will notify you of a decision within 30 days.

Who can help me file an expedited appeal?

You, your child’s doctor, another provider, or anyone you choose can ask for an expedited appeal.

What else can I do if I’m still not happy?

If you disagree with UnitedHealthcare Dental’s appeal decision, you have the right to request a review by MAXIMUS Federal External Review within 4 months of the decision. MAXIMUS does not have an affiliation with UnitedHealthcare Dental, your health care providers, or the URA.

To request a MAXIMUS Federal External Review, you must fill out the MAXIMUS Federal External Review Request form which can be found on member website and return it by:

Mail:
MAXIMUS Federal Services
HHS Federal External Review Request
3750 Monroe Avenue, Suite 705
Pittsford, NY 14534, or

Email: FERP@maximus.com, or

Submit a request online at:
https://externalappeal.com/ferpportal/#/home
Select the link “Request a Review Online” in the heading, or

Fax: 1-888-866-6190, or

Call: 1-888-866-6205
8:00 a.m. – 5:00 p.m. EST, Monday – Friday

If you believe your situation is urgent, you may ask for an expedited (fast) review when emailing, faxing or by calling the Federal External Review Process at 1-888-866-6205 ext. 3326. If submitting the review request online select “expedited.”

The patient, parent, or the patient’s legal guardian must sign the consent to release medical information to MAXIMUS (included as part of the review request form).

MAXIUMS Federal Services will provide notice of the final external review decision as quickly as your medical conditions or circumstances require, but no later than 72 hours after they receive your expedited external review request. When MAXIMUS Federal Services receives your request, they will notify us, and we will send them all the case information for their review. If you send them any more information they will share it with us.

You will receive a letter with their decision for a standard request no later than 45 days after they receive the request for the external review. If MAXIMUS Federal Services decides to overturn our decision, we will provide coverage or payment for your health care items or services.

If you have questions or concerns about your external review, call 1-888-866-6205.


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