Luxor Dental Plans, Inc. ("Luxor") encourages its Enrollees to resolve any complaints or grievances through the procedures outlined in this Grievance Policy. Grievances may be filed, and grievance forms can be obtained, by mail, fax or telephone. If filing by mail or fax, please use the Grievance Form enclosed in your Enrollee packet.

If by mail, to Luxor Dental Plans, Inc.:

Attention: Director of Quality Assurance – Grievances
11111 Richmond Ave., Ste. 219
Houston, TX 77082

If by fax, submit the completed form to: (713) 414-4953

If by telephone, call (877) 332-1264

Luxor's Grievance Policy addresses the linguistic and cultural needs of its Enrollee population, as well as the needs of Enrollees with disabilities. The system ensures all Enrollees have access to and can fully participate in the grievance system by providing assistance for those with limited English proficiency, or with a visual or other communicative impairment. Such assistance shall include, but is not limited to, translations of grievance procedures, forms, and plan responses to grievances, as well as access to interpreters, telephone relay systems, and other devices that aid disabled individuals to communicate. Enrollees may file a grievance under this Grievance Policy for up to one hundred and eighty (180) calendar days following any incident or action which gives rise to the Enrollee's dissatisfaction.

Luxor is responsible for and will resolve service-related problems, including availability and accessibility of providers, pricing or billing disputes, the sales process, and other service-related problems. Luxor monitors and assists in resolving quality of care-related issues of Enrollees. Luxor will assist Enrollees in identifying and contacting the appropriate state professional licensing agency to report quality of care–related problems (e.g. The Dental Board of Hawaii, Department of Commerce and Consumer Affairs, etc.)

Documentation

Luxor will maintain a written record of each grievance submitted under this Grievance Policy. The written record shall include: the date the grievance was received; the name of the Luxor representative that processed the grievance; a summary or other documents explaining the nature of the grievance, and a summary of the resolution. Written communication from the Enrollee, must include:

  1. The name of the patient
  2. The address, telephone number and identification number of the Primary Enrollee
  3. The name of the Enrollee and
  4. The Dentist's name and facility location

A complaint does not include a misunderstanding or problem of misinformation which can be promptly resolved by supplying correct information to the Enrollee's satisfaction.

We do not make determination about the medical necessity of dental services and only determine if the services are covered Benefits under the Contract. We will provide notification if any dental services are not covered Benefits, stating the specific Contract provision(s).

  1. Luxor will retain copies of grievances, responses, and resolutions for five years. When applicable the records shall contain all documents, evidence and other relevant information upon which Luxor relied in reaching its decision.
  2. Grievance forms shall be available as outlined above. Additionally, Luxor will have the Grievance Policy and Grievance Forms included in the Enrollee packets and provider packets, so that Enrollees will have access to these forms in their initial packet, as well as at each contracted provider's office or facility.
  3. Grievances filed under this Grievance Policy shall not affect the Enrollee's status in any way. Luxor will enforce a strict no-tolerance policy against discrimination based upon the filing of a grievance under this Grievance Policy.
  4. Enrollees may file a grievance under this Grievance Policy for up to one hundred and eighty (180) calendar days following any incident or action which gives rise to the Enrollee's dissatisfaction.

Response & Resolution

  1. Grievances received under this Grievance Policy shall be acknowledged by written response within five (5) business days. The written response will advise the Enrollee that his/her grievance has been received, the date of receipt, and provide the names of the department and representative handling the grievance, along with the telephone number and address of the Luxor representative who may be contacted about the grievance. All grievances will be resolved within thirty (30) business days from submission and will be reviewed from time to time by Luxor's officers and governing body to identify patterns regarding grievances as presented by the applicable management and supervisory staff. A clear and concise written response to the Enrollee will be provided within thirty (30) business days.
  2. Notwithstanding section one (1) above, grievances received by telephone that are resolved by the close of the next business day, will not be answered by written acknowledgment and response. Luxor shall maintain a log of all grievances that do not require a written acknowledgment containing the date of the call, the name of the complainant, Enrollee identification number, nature of the grievance, nature of resolution, and the Luxor representative's name, who took the call and resolved the grievance. The information contained in this log shall be periodically reviewed by Luxor's officers and governing body.
  3. Grievance reports will be shared quarterly with the appropriate management and supervisory staff responsible for the Grievance to ensure Enrollee and Provider concerns are addressed.