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Delta Dental targeted by two states' dentists

June 28, 2017

By David Burger

 
Special delivery: Washington State Dental Association President Dr. Bernard J. Larson (right) and Executive Director Bracken Killpack deliver signed petitions to Delta Dental of Washington's Seattle headquarters on Monday, June 19.
Dentists in Washington and Massachusetts delivered petitions to their respective Delta Dental organizations alleging interference with the dentist/patient relationship.

The petitions, both delivered the same week in June, were independent of one another but are intended to address similar grievances.

More than 25 dentists in Massachusetts, calling themselves the Mass Dentists Alliance for Quality Care, filed a petition June 21 asking the state attorney general to investigate Delta Dental's insurance practices. The group is not affiliated with the Massachusetts Dental Society.

In Washington, Dr. Bernard J. Larson, Washington State Dental Association president, and Bracken Killpack, executive director of the WSDA, hand-delivered a petition to Delta Dental of Washington's Seattle office June 19 with about 650 signatures of Washington dentists who are Delta Dental members and calling for special meetings with Delta Dental. The petitions were submitted pursuant to a special meeting provision in the Delta Dental of Washington's bylaws, and follow what Mr. Killpack referred to as instances of Delta Dental failing to respond to dentists' concerns with the insurer interfering with the dentist-patient relationship.

Massachusetts

James C. Donnelly, Jr., of the Worcester, Massachusetts, law firm Mirick O'Connell, delivered the Massachusetts dentists' petition to state Attorney General Maura Healey. The petition alleges that Delta Dental of Massachusetts, the state's largest dental insurer, violated nonprofit rules and engaged in anticompetitive behavior.

Mr. Donnelly said the state's Delta Dental is "coercing dentists to accept a low-cost plan" and is "threatening the dentists with a loss of their business." Delta Dental is "putting a gun to dentists' heads," he said, because of their dominance in the state.

Dr. Jill Tanzi, a member of the group of dentists who initiated the petition, said she received a new Delta Dental contract around Christmas and immediately became concerned that she was being coerced into signing something she didn't agree with. She spoke with a friend of hers who was a lawyer. "She said it seemed like a one-sided contract with unfair business practices," Dr. Tanzi said.

"We already take a big hit on Delta Dental," Dr. Tanzi said. She said the new PPO plan would reimburse her about 25 to 30 percent less than she would receive under the current Delta Premier plan. "It's not a good contract to sign."

The petition alleges that Delta Dental's business practices interfere with consumer choice and discriminate against dentists who refuse to join the newly formed plan.

The petition was prompted by Delta Dental's announcement in late 2016 that it would consolidate its nonprofit, popular Delta Dental Premier dental service plan into a new for-profit plan that combines it with the less popular Delta Dental PPO plan.

According to the petition, Delta Dental has improperly discriminated against dentists who only participate in the Delta Dental Premier plan by unfairly directing patients to dentists who have agreed to participate in the company's lower-reimbursement PPO plan.

The petition also alleges that the new Delta Dental insurance plan will be administered by a for-profit company funded by its nonprofit parent, the original Delta Dental, and also improperly uses the trademarks and goodwill from the nonprofit side to generate money for the for-profit side.

In recent years, Delta has taken steps to move all business over to a for-profit entity doing business as Delta Dental of Massachusetts, according to Dr. Tanzi. The shift to for-profit is important in that the state will no longer be afforded the authority to oversee many of Delta's business practices, said Dr. Tanzi. Delta is inserting itself in between the dentist/patient relationship, she said, by threatening a provider's ability to treat patients without getting hurt financially.

"While the Massachusetts Dental Society is not involved with the recent petition group, it did initiate a request in January urging the state attorney general to look into Delta Dental of Massachusetts' nonprofit to for-profit company transition and business practices, said Dr. Robert Boose, executive director of the society. "The society has been involved in an ongoing dialogue with the attorney general," Dr. Boose said. "The society's legal counsel continues to provide supporting information to move this request forward and has also provided consultation to the lawyer representing the petition group since their concerns are similar," he said. "It's a redundant exercise," he said of the petition. "They're asking for something we already asked for. Unfortunately, this is an extensive process."

Dr. Tanzi said she was under the impression that the Massachusetts Dental Society supported their efforts. "It'd be nice to work together, to stick together and not cause any conflict," she said. "The issues the Massachusetts Dental Society brought up in January are closely related and we have similar goals, but our petition raises additional issues such as unfair competition and interfering with patient choice."

Kristin LaRoche, spokeswoman for Delta Dental of Massachusetts, said there were "many factual inaccuracies" in the petition submitted June 21. "It's unfortunate that at a time that the health care community across the state is coming together to combat rising health costs, a small group of dentists are opposing our efforts to do the same in dental care.
 
"The rising costs of dental care are squeezing the budgets of families and small businesses across the state, threatening access to care for thousands of people. Our move to establish a PPO is a necessary step to increase consumer choice by immediately making a more affordable option available. It will also create a strong platform for value-based, quality-driven initiatives to improve health outcomes.
 
"As an oral health community, we have two choices. The first is to innovate and make dental coverage more value-based and affordable. The second is to protect the status quo and threaten access to care. Delta Dental is committed to working with the many talented dentists who understand that affordability through innovation is the only sustainable path for the dental community, patients, and the Commonwealth of Massachusetts."

"The dentists are standing up for patients' rights to make informed choices about the quality, cost and convenience of the dental services they consume," said Mr. Donnelly. "If costs of some providers become too high, the free market will take care of it. This is an opportunity for the dental profession to stand up for the public in the face of large corporate interests that are primarily concerned about their own interests, and I hope dentists will take advantage of it."
 
Washington

Launched at early June's Pacific Northwest Dental Conference, the petition effort in Washington state was not coordinated with the Massachusetts petition, Mr. Killpack said, but many of the themes are similar.

With nearly 650 signatures collected in less than 24 hours, the petition calls for special meetings to begin the process of making a series of amendments to the company bylaws for Washington Dental Service/Delta Dental of Washington. "Each of the proposed bylaw amendments reflects our efforts to enhance the doctor-patient relationship by shifting Delta's focus back to patients and their providers," said Dr. Larson. "The changes are also designed to give Delta member dentists more visibility into its operations and how they impact patient care."

"Delta Dental has been nontransparent," Mr. Killpack said.

Upon receipt of the petition, with signatures of at least 10 percent of its member dentists, Delta is required to schedule the requested meetings and announce the date of those meetings within 30 days.

The proposed bylaw amendments would, Dr. Larson said, ensure Delta's decisions are patient care-focused; make Delta more responsive to patients and its member providers; and give Delta members more visibility into its operations. One amendment would require that 94 percent of Delta revenues be directed to paying for patient care, and that any administrative costs above 6 percent of revenues be refunded to those purchasing coverage.  

Another would require that Delta participate with the Washington State Insurance Commissioner's office in an independent review panel process when there are disagreements between the company and a provider over a claim payment, as medical insurers in Washington do.

Finally, another requirement would require Delta to disclose the percentage of claims that are denied and, of those, the percentage that were reviewed by a licensed dentist in making the denial decision.

Mr. Killpack said that these measures, taken collectively, would help make Delta "more of a partner than an interloper in a healthy doctor-patient relationship." These proposed bylaw amendments are not an effort to reform the fee structure that Delta imposes on its member dentists, he said.

He added that the move by the Washington State Dental Association was emboldened by legal standing established by a recent California Dental Association's lawsuit settlement with Delta Dental of California. "There is a trend across the country," he said, of dissatisfaction with Delta Dental and a willingness to take action on behalf of patients and the dentists who serve them.

Delta Dental began in Seattle in 1954 as the first dental benefits company in the U.S. Attempts to reach Delta Dental of Washington were unsuccessful.