Reconsideration

A reconsideration is a formal request made by a member or a dentist to United Concordia to seek a separate review from the initial payment determination. This review will assess whether or not the initial payment decision was correct.

Requesting a Reconsideration
A request for reconsideration must be submitted in writing to:

The reconsideration request must include:

• The reason(s) for the request
• Supporting documentation (X-Rays, progress notes, treatment records and PCS orders, if applicable)
• A copy of the initial determination

The reconsideration request must be postmarked or received by United Concordia within 90 calendar days of the issue date of the Dental Explanation of Benefits (DEOB). Because the request for reconsideration must be filed within 90 days, the appeal request should not be delayed to obtain supporting records if these records are not readily available. You may submit supporting records at a later date; however, you should include the expected date of submission in the appeal letter.

What Happens During a Reconsideration?
United Concordia's Customer Service Representatives will review all documentation submitted and conduct a thorough investigation. They may contact you, the family member or the dentist for additional information, and, in some cases, may refer the claim to United Concordia's Dentist Advisors.

The reconsideration may result in full or partial approval of the disputed costs, or confirmation of the initial decision. Written notification of the reconsideration decision and any action taken will be issued within 60 days of the receipt of the appeal request. No matter who requested the reconsideration, you will receive a copy of the reconsideration decision. The participating dentist (or a nonparticipating dentist who has been appointed as representative or who has benefits assigned to him or her) will also be notified.