** Notice for ADDP Members Impacted by Natural Disasters **

United Concordia is dedicated to helping ADDP members impacted by natural disasters. We realize you are wrestling with many issues and concerns in light of this tragedy - your dental care shouldn't be one of them.

If you have been displaced as a result of a natural disaster and your ADDP benefits and/or access to care have been affected, please contact us at 1-866-984-2337. We are committed to helping our enrollees affected by tragedy. Please do not hesitate to contact us so we can be of assistance.

skip to main content

Appeals and Grievances

Appeals

Active duty service members (ADSMs) are required to have a military DTF referral prior to accessing private sector dental care. If they do not receive one prior to receipt of care, the claim may be denied. Their claim may also be denied if they receive care from a civilian dentist that was not included on the DTF referral.

The ADSM may appeal a claim denial by completing the online appeal form. The form must be completed in its entirety. The required information can be found on the ADSM’s dental explanation of benefits (DEOB).

DTF staff can submit an appeal through DART+ by logging in and selecting the “Create New Appeal” button. DTF staff can locate the information required to submit an appeal in DART+ and DISC. 

DTF staff and ADSMs may also choose to submit an appeal in writing detailing why you are appealing denied charges. You should also include a copy of the bill. Paper appeals should be sent to United Concordia at:

United Concordia Companies, Inc.
ADDP Unit - Appeals
P.O. Box 69430
Harrisburg, PA 17106-9430

 

Grievances/Quality of Care Concerns

United Concordia is committed to providing quality outcomes through our network of dental professionals. We have a Dental Oversight Committee comprised of experienced dentists that credentials network providers every three years and monitors quality issues. Actions to correct quality issues include educational letters to providers, review of their patient records, in office review of records and examination of patients by a dental director, and termination from the network. We employ benchmark utilization reviews to ensure network dentists provide industry-standard levels of treatment. Our team of dentist advisors perform pre and post payment clinical reviews. United Concordia has well established Grievance and Appeal programs to ensure enrollee satisfaction and address quality concerns. In the event that you have a quality concern regarding procedures that have been performed by a United Concordia network provider, please address them in the following manner:

  • Either the ADSM or the DTF should address the first incident regarding clinical quality with the treating dentist to provide an opportunity to rectify the concern. If preferred, the DTF can request that United Concordia contact the treating dentist for corrective action.
  • If the treating dentist does not correct the issue after the initial request, the ADSM or DTF should contact United Concordia to address the concerns.

To file a grievance, submit the online Grievance Form to United Concordia. You may also print and mail or fax this form to United Concordia. The printed form can be faxed to 717-635-4560 or mailed to

United Concordia

ADDP – Grievances

4401 Deer Path Road, DP-1E

Harrisburg, PA 17110-3907

For more information about the grievance process, consult the Quality of Care Concern Flow Chart.

HOME | ADSM/AGR | CIVILIAN DENTISTS | GOVERNMENT/PROGRAM ADMINISTRATORS