Comfort Dental Downtown

We became effective as providers with your company in July 2018. Throughout this enrollment process, we have made several corrections in regards to adding our suite number and correction of fax number through email, by submitting a letter and also through the credentialing department personally with Mellisa Hernandez.

During the course of this time we have also seen a patient, [removed]. We have been waiting for payment on this account since DOS 08/01/2018. My first contact with your representative, Emily, on 9/6/18 was not correct information. Emily states to me that check #[protected] for $555.50had been received by our office. I spent much time looking through bank accounts to track down the amount provided but could not find a deposit. I was not able to receive an EOB or copy of the check as the corrections to our address and fax had yet to be corrected and was given contact information for Mellisa Hernandez. I contact Ms. Hernandez and am told that the corrections have already been done and does not understand why Humana has not corrected the information.

9/18/18 I call again and speak with Katie, supervisor, ref [protected]. She states that she is escalating the claim as well as the issue with the fax number and correction. She states she has made contact with Mellisa and confirmed that the changes have already been made from credentialing and states that she will make an exception and fax over the EOB to assist me in finding the payment. Unfortunately, I did not receive the fax.

9/19/2018 and now I call to speak to supervisor Sunshine, ref # [protected]. Not only did Emily ( previous rep) give me the wrong information; the check was in the amount of $900 plus. $555.50 is the patients anticipated co-payment and the check was mailed to an address in California. Now this poses a serious issue as NOWHERE in our credentialing paperwork is there a California address listed. Our TID and NPI are both registered to doctors who reside and practice in COLORADO!!! Once again, I am on the phone with Ms. Hernandez, who verifies again that she has submitted the correction multiple times and does not have California anywhere in our registration. During this call Sunshine states that she will reissue the check and send to our address. She shows that our address has been in the system this entire time and not sure why it was not updated, states it should be 5-7 days. I have yet to receive a check!

10/04/2018 I call Humana again to get a male representative. After explaining the whole situation, he has no response to give me and could not come up with any answers to my questions so I am transferred to Sunshine again. She tries to state that the issue was not on Humana’s end but from credentialing with Connection Dental. Of course, this is not so as I have been working closely with Mellisa, who is in charge of the credentialing and well aware of the situation. It was during this coversation that I state I am turning your company over to the insurance commissioner as it is well over your time limit for payment. Sunshine places me on hold for a very long time and never returns to the line. I am not sure if the call was discontinued or dropped, however, she never bothered to call back and finalize the conversation.

10/09/2018 and now my conversation is with a supervisor above Sunshine, her name is Tiffany ref #[protected]. She states that she can see the corrections in one screen but the corrections have not been changed on another screen and therefore the check has not been issued. Now this is infuriating to me as I cannot fathom how your representatives have no concept of customer service. How difficult is it to make this correction or follow up with the case. If they are not competent to handle completing a task, then it should have been presented to a higher authority for completion. Tiffany states that she is marking this situation urgent and that the correction should be made within a week and I should receive payment. It has been over 60 days without payment. I cannot even log into your portal for verification because I have to submit copies of two checks received on payment. How is this possible if your company cannot even figure out how to correct something so simple as an address. All corrections have been made in the correct departments and yet we are still presented with these unfortunate events.

I am writing this complaint in hopes that someone will find it, read it and actually acknowledge that there is an internal problem. I hope that it does not just get mixed up with the other 1046 complaints that I see are listed against your company. It is tragic that as a corporation, the level of customer service not only to providers but also to your consumers is not only low but very unprofessional and without regards to the contract that we both are to abide by. We will continue to pursue formal complaint against your company with the Colorado Insurance Commissioner and any other agency inclined to address issues such as these. The desired resolution is that you mail the amount due our office for services rendered to your insured immediately.

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