You and your dentist may have a bone to pick with Delta Dental

Dr. Neal, who is the current president of the Seattle-King County Dental Society, recently wrote an article for the Seattle Times. Below is a link to the page as well as the article.  Nice job Dr. Neal!!!

You and your dentist may have a bone to pick with Delta Dental
Originally published November 5, 2017 at 12:01 pm Updated November 3, 2017 at 3:07 pm

Doctor Craig

By Craig E. Neal
Special to The Times

Something important happened for oral health in Washington. Dentists across the state closed their offices for a day in September and met to vote on bylaw amendments to make Delta Dental of Washington, the state’s largest dental benefits carrier, more patient-focused, transparent and responsive to member dentists.

In this day of razor-thin margins and contested elections, the results weren’t even close: More than 91 percent of the votes cast supported the changes.

Despite this overwhelming majority, Delta has chosen to act as if it never happened. If Delta has its way, almost none of the member-voted changes will matter. Patients will continue to see premiums rise with few options to seek coverage elsewhere. Their dentists’ clinical decisions will continue to be overruled by insurance clerks, resulting in services delayed and claims denied.

That is because Delta’s board of directors recently vetoed virtually all the changes, effectively ignoring the clear direction provided by Delta members who voted to support the amendments.

These member dentists understand exactly how these changes will benefit their patients and how harmful the board’s veto is.

One vetoed amendment would have required Delta to establish an independent review board, administered by the Insurance Commissioner’s Office, to deal with disputed claims. That is the way medical insurance works: Disputed claims can be submitted to an independent panel that reviews the doctor’s recommendations and the insurer’s position and makes a final, binding determination. But Delta continues to oppose any resolution process that would take the final decision out of its hands. The insurance commissioner has virtually no authority to intervene on behalf of dental patients caught in the middle, thereby removing an important piece of public protection.

Another vetoed amendment would have required Delta to dedicate 94 percent of their premium revenues to paying dental claims from patients like you. If Delta did not meet this target, it would have been required to issue refunds to those purchasing coverage. This was the percentage Delta reported paying out in 2011, when trumpeting the efficiency of its operations, so it would seem a reasonable target today.

As the head of a nonprofit company, CEO Jim Dwyer, whose salary has more than doubled to $2.75 million over the last six years, claims Delta can no longer afford to dedicate that much to patient care. The board of directors, all now receiving more than $100,000 for part-time service on a nonprofit board, agrees.

Their position demonstrates how patient benefits increasingly are taking a back seat to advertising, salaries and other overhead. Delta’s bottom-line focus ignores what their members are saying is best for patients, a trend that sadly isn’t new.

In addition to their vetoes, the board canceled the organization’s annual meeting, depriving member dentists of another opportunity to advocate on behalf of their patients.

Instead, Delta suggests their Member Advisory Committee hold a forum to discuss the issues. But they’ve also vetoed a provision to require the board to publicly vote on recommendations from that very committee. They’ve even written the committee out of the organization’s bylaws — without a vote of the members.

In short, Delta’s response continues a well-established pattern of resisting any accountability to member dentists, the patients they serve, or state regulators. So, the battle for accountability is likely to shift to the courtroom. Dollars that should be going to patient care or promoting oral health instead will be spent on lawyers.

This isn’t just a spat between the state’s largest dental-benefits provider and its member dentists. As patients, the public has a significant stake in the outcome. If the dentists’ reforms are upheld, patients will get more money going to their care, more transparency about how their premium dollars are spent, and access to a legitimate, independent forum for resolving disputes with their insurance company.

Craig E. Neal