Editorial: Delta’s struggle with dentists calls for extraction

By The Herald Editorial Board

There’s this nagging ache that Washington Dental Services, the state’s largest dental insurer, really needs to see its dentists about.

The pain, ignored last fall by the board of directors for Washington Dental Services, also known as Delta Dental, has only gotten worse and recently resulted in a call by the Washington State Dental Association, which represents the state’s dentists, for the extraction of Delta’s chief executive in Washington, Jim Dwyer. The petition, signed by 1,500 of Delta’s 4,500 member dentists, says the dentists have lost confidence in Dwyer and want the board to remove him in advance of his planned retirement in January 2019.

The problem for Washington Dental Service started last year when hundreds of its member dentists petitioned Delta’s board of directors for a special membership meeting to consider a slate of amendments to Delta’s bylaws. Dentists with WSDA had expressed concerns about increasing marketing and other administrative costs, including its move from its former Northgate location to 61,000 square feet of leased space in Seattle’s South Lake Union, amid Amazon, the Allen Institute, UW Medicine and the Seattle Cancer Care Alliance.

Delta’s dentists also had complaints about a steady rise in the nonprofit’s reserve funds and continuing frustration among dentists and patients with denial of claims and procedures and delays in care. Last August, the Herald Editorial Board met with Dr. Marissa Bender, a Lynnwood dentist and past president of the Snohomish County Dental Association, who said she had to write off charges for some of her patients because Delta either required a delay in a procedure that she felt was not in a patient’s interest or because a pre-authorized procedure was later denied coverage by Delta.

There was concern, said Bracken Killpack, the WSDA’s executive director, that some decisions on whether a procedure would be covered were being made by computer algorithms rather than by dentists with knowledge of patient care.

Among the bylaw changes that the dentists sought:

Require Delta to work with the state Office of the Insurance Commissioner and participate in an independent review board regarding disputes between Delta and dentists regarding patient care and denied claims, as other medical insurance providers are required to do;

Restrict administrative expenses to 6 percent of revenue, devoting 94 percent of revenue to patient care, refunding any revenue over that cap to Delta customers; and

Improve transparency regarding expenses, financial statements and on the percentage of claims denied and which denied claims had been reviewed by a dentist.

Last September, during the special meeting of the insurer’s board of directors in Lynnwood, which member dentists either had to attend in person or vote by proxy, 2,300 of Delta’s dentists — a majority of its 4,500 members — cast ballots with 91 percent voting to approve the bylaw amendments.

The response by Delta’s board? It vetoed the bylaw amendments and canceled the annual membership meeting that is typically held each fall.

The struggle between Delta and its dentists has not received much news coverage, playing out mostly through op-ed columns.

Dwyer, in an opinion piece in The Seattle Times in November, claimed that some of the bylaw changes sought would have violated antitrust laws or the organization’s fiduciary duty to manage the insurer for long-term stability. Dwyer also said that of the 15 million dental procedures in 2016 submitted to it for processing, it disallowed less than one-half of 1 percent.

But even that low percentage means that payment was rejected for somewhere near 75,000 claims. We have to say “somewhere,” because the rejection of one of the suggested bylaw changes means Delta doesn’t have to report the actual figures to its member dentists or its customers.

The blanket rejection of the bylaw amendments by Delta’s board — sought by an overwhelming majority of its member dentists who attended the September meeting — represents a crisis of confidence among providers for an insurer that covers more than 2 million of the state’s 7 million residents.

Removing a CEO who has less than a year left before retirement may sound like an unnecessary procedure to some, but for Delta to restore the confidence of its dentists, at least 1 out of 3 dentists agree it is.

Correction: In an earlier version of this editorial, WSDA Executive Director Bracken Killpack’s first name was incorrect.