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Thursday, March 21, 2019  Spokane, Washington  Est. May 19, 1883
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Opinion >  Guest Opinion

Dr. Mark Paxton and Dr. Ashley Ulmer: Delta Dental should adopt patient-centered reforms

By Dr. Mark Paxton and Dr. Ashley Ulmer For The Spokesman-Review

Day after day, dentists in Eastern Washington and across the state see the frustration of our patients, who regularly pay increasing dental insurance premiums only to see their claims for necessary care questioned, delayed or denied.

We are working to correct that problem by proposing fundamental changes in the practices of Washington Dental Service (Delta Dental of Washington). It’s an effort that every potential insurance buyer or patient should care about.

Patients have very few dental insurance options, and Delta is by far Washington’s largest dental insurer, providing most of the group insurance policies to employees of major public and private sector employers in Eastern Washington and around the state. But Delta is exempt from most of the rules other health insurance companies must abide by. This gives them tremendous power to directly influence how your dental care is delivered.

Unfortunately, in recent years, that influence has not served patients well. Rapidly escalating executive compensation and other administrative expenses reduce the pool of premium money available to pay claims. Pre-authorized service claims are being denied after the fact. Dentists and patients alike see their claims being questioned or rejected by Delta employees who lack the professional training of a licensed dentist.

As medical professionals, we know that the best care results when doctors and patients build close, trusting relationships and agree on a course of care without outside intrusion. Delta’s business practices have routinely placed the company squarely between patients and the licensed dentists caring for them.

Practicing dentists sitting on Delta’s Member Advisory Board have repeatedly raised these issues. The concerns have gone largely ignored. That’s why dentists from across Washington are actively pushing back against these intrusions on the doctor-patient relationship.

A group of dentists who accept Delta insurance have engaged experienced attorneys and have proposed a series of common-sense amendments to Delta’s bylaws, using a process provided for by the organization. The amendments will return the patient focus to the company’s decision-making and make it more responsive and transparent to provider concerns. They include:

  • Requiring Delta to commit 94 percent of the premiums they collect to patient care. Administrative expenses would be capped at 6 percent. If Delta fails to achieve this ratio, then it will be required to issue refunds to its policyholders to achieve the 94 percent ratio.
  • Requiring that Delta cooperate with the Office of the Insurance Commissioner to implement an independent review board for stand-alone dental benefit plans, similar to the board that hears disputes with medical insurance providers.
  • Redefining the role of Delta’s independent directors to comply with IRS regulations for nonprofits. Currently, Delta maintains that anyone with a dental degree cannot be “independent,” which prevents insured patients from the benefits this professional expertise could provide in Delta’s decision-making.
  • Requiring that Delta publish statistics regarding the percentage of claims that it denies and, of those, the percentage where the decision is made or reviewed by a licensed dentist.
  • Replacing Delta’s current practice of hand-picking its board of directors with a system of contested elections, which will result in a stronger, more independent board.

All of these changes reflect our fundamental concern, that Delta has lost its patient focus and systematically eliminated input from the people who know patients best, their dentists. These changes are designed to reverse that trend.

While Delta’s initial reaction to these changes has not been positive, our sincere hope is that eventually they will recognize that our proposals are based upon the best interests of the patients we all serve.

Dr. Mark Paxton is president of the Spokane District Dental Society, and Dr. Ashley Ulmer is a board member of the Washington State Dental Association.

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