Harbor Health Case
The following are the responses to Ms. Allen’s documented questions/concerns and our collective responses:
Case# 11802 – On 2/4/2016, Ms. Allen had a dentist appointment and DENCAP was not showing up. She called Harbor Health and was told she should have dental insurance because her premium was paid, but a spreadsheet which needed to be completed with her name had not been sent to DENCAP, so she had to cancel her appointment. Ms. Allen said she called DENCAP twice and DENCAP contacted Harbor Health but had not received a call back and no one addressed the concern further with her. She mentioned that she has been unable to use her insurance despite having paid for it and attend appointments due to errors made by Harbor Health. Ms. Allen
requested to be contacted directly to discuss the matter further. o Response – According to Steven Palmer, Internal Lead Consultant and Account Manager at DENCAP, DENCAP could not verify the Ms. Allen’s coverage due to an issue with an eligibility file conversion error. DENCAP attempted to help by making a call to Harbor Choice and was advised that we were still converting the Harbor eligibility file into the DENCAP system and was not due to be completed until 2/9/2016. He advised us that Ms. Allen was informed of the eligibility file issue and that someone from DENCAP Customer Services would call her once the conversion completed. o Response – Steven Palmer reported that Ms. Allen was contacted on 2/9/2016 with updated information that she was retroactively effectuated with coverage beginning on 1/1/2016 based on the eligibility file that was submitted by Harbor Choice to DENCAP. Ms. Allen stated that she was pleased and a fax of eligibility was sent to Great Expressions Dental Center of Allen Park, MI stating the member’s effectuated coverage date. o Response – Lisa Marmalejo, Manager of Member Services - Harbor Choice called Ms. Allen on 2/9/2016 and 2/11/2016 but did not reach anyone. She left a voice message that included her contact information and requested a call back. She called DENCAP on 2/11/2016 and was informed that they spoke with Ms. Allen on 2/9/2016 and advised her that they have her DENCAP benefits updated in their system.
Case# 11802 – On 2/4/2016, Ms. Allen had a dentist appointment and DENCAP was not showing up. She called Harbor Health and was told she should have dental insurance because her premium was paid, but a spreadsheet which needed to be completed with her name had not been sent to DENCAP, so she had to cancel her appointment. Ms. Allen said she called DENCAP twice and DENCAP contacted Harbor Health but had not received a call back and no one addressed the concern further with her. She mentioned that she has been unable to use her insurance despite having paid for it and attend appointments due to errors made by Harbor Health. Ms. Allen
requested to be contacted directly to discuss the matter further. o Response – According to Steven Palmer, Internal Lead Consultant and Account Manager at DENCAP, DENCAP could not verify the Ms. Allen’s coverage due to an issue with an eligibility file conversion error. DENCAP attempted to help by making a call to Harbor Choice and was advised that we were still converting the Harbor eligibility file into the DENCAP system and was not due to be completed until 2/9/2016. He advised us that Ms. Allen was informed of the eligibility file issue and that someone from DENCAP Customer Services would call her once the conversion completed. o Response – Steven Palmer reported that Ms. Allen was contacted on 2/9/2016 with updated information that she was retroactively effectuated with coverage beginning on 1/1/2016 based on the eligibility file that was submitted by Harbor Choice to DENCAP. Ms. Allen stated that she was pleased and a fax of eligibility was sent to Great Expressions Dental Center of Allen Park, MI stating the member’s effectuated coverage date. o Response – Lisa Marmalejo, Manager of Member Services - Harbor Choice called Ms. Allen on 2/9/2016 and 2/11/2016 but did not reach anyone. She left a voice message that included her contact information and requested a call back. She called DENCAP on 2/11/2016 and was informed that they spoke with Ms. Allen on 2/9/2016 and advised her that they have her DENCAP benefits updated in their system.