Dr. [redacted] has forwarded a copy of her response to Ms. ***'s complaint to theCarePlus Grievance Committee.Services rendered by an out-of-network provider are not a covered benefit of theCarePlus policy Ms. [redacted] is enrolled in without prior-authorization or approval, unless itis for emergency treatment outside the service area. However, upon review, thecommittee has authorized additional payment for the services rendered to her.We apologize for Ms. ***'s dissatisfaction with the services provided by DentalAssociates and the benefits provided in her CarePlus managed care policy. In the future,Ms. [redacted] must receive fonnal written prior approval before seeing any out-of-networkproviders, including any specialty providers from CarePlus Dental Plans. In addition, weask that she use the grievance process indicated in her policy for appeals should the needarise.We suggest that Ms. [redacted] contact the Dental Associates Clinic [redacted] or [redacted] at the [redacted] facility if she requires additional dental treatment or hasconcerns about the quality of care she has received.
Dr. [redacted] has forwarded a copy of her response to Ms. ***'s complaint to theCarePlus Grievance Committee.Services rendered by an out-of-network provider are not a covered benefit of theCarePlus policy Ms. [redacted] is enrolled in without prior-authorization or approval, unless itis for emergency treatment outside the service area. However, upon review, thecommittee has authorized additional payment for the services rendered to her.We apologize for Ms. ***'s dissatisfaction with the services provided by DentalAssociates and the benefits provided in her CarePlus managed care policy. In the future,Ms. [redacted] must receive fonnal written prior approval before seeing any out-of-networkproviders, including any specialty providers from CarePlus Dental Plans. In addition, weask that she use the grievance process indicated in her policy for appeals should the needarise.We suggest that Ms. [redacted] contact the Dental Associates Clinic [redacted] or [redacted] at the [redacted] facility if she requires additional dental treatment or hasconcerns about the quality of care she has received.