On January 9, 2018, five prominent dentists in the state of Washington filed a formal complaint against Washington Dental Service (WDS, dba Delta Dental of Washington) with their state’s Office of the Insurance Commissioner (OIC).1 The complaint alleges a consistent pattern by WDS with lack of transparency to member dentists.
Allegedly, officers and directors changed the bylaws and structural organization of Delta Dental of Washington, a nonprofit 501 (c)(4), without a complete and timely notification to member dentists in 2013. The complaint further states that member rights of this nonprofit insurance carrier were violated by disallowing member participation in the process.
The complaint goes on to allege WDS misrepresented members dentists’ right to vote to the state’s OIC and that their rights would not change after reorganization. Member dentists advocated for bylaw amendments, which they state WDS declined to disclose to the OIC and that member dentists approved by a favorable vote of 91%, in 2017. These bylaw amendments would have required WDS to:
- Pay a larger percentage of the premiums it collects into patient claims (94%) or refund the excess to premium-payers.
- Remove the disputed claims review process from the exclusive decisions of WDS and allow final disputed claims to be independently reviewed by the OIC review process, a process that’s similar to medical insurance claims disputes.
- Require additional disclosures of WDS’s administrative, lobbying, and advertising expenses.
- Increase financing for membership involvement in decision-making and corporate governance.
“We are committed to seeing the organization’s governance structure, operating practices, and communications change to support patient care,” said Bernard Larson, DDS, immediate past president of the Washington State Dental Association. “It’s time to begin restoring trust and mutual cooperation between Washington’s dentists, patients, and the state’s largest dental benefits provider.”
WSDA president Cynthia Pauley, DDS, released an overview of the complaint to membership of the WSDA.2 Signed by her and four other leaders in Washington dentistry, the letter was emailed to Washington dentists. It detailed the extent of alleged misrepresentations by WDS and the beneficial reforms that the WSDA wanted to see in the nonprofit insurance company’s operations.
Also, the letter alleged that WDS went to lengths to disenfranchise the rights of member dentists. It then singled out WDS CEO James Dwyer for a pattern of alleged misrepresentations and self-serving manipulations to both Washington dentists and the Washington State OIC.
“We are aware that the Washington State Dental Association leadership has filed a complaint with the Office of the Insurance Commissioner (OIC) regarding Delta Dental’s corporate structure,” WDS responded.
“Our corporate structure changes were made in compliance with applicable law and OIC regulations; the heavily regulated nature of our industry also requires us to regularly file statements with the OIC,” WDS continued.
“We feel confident in our continued ability to pursue our vision: that all people can enjoy good oral and overall health with no one left behind. And we pursue this vision, under our current corporate structure, in collaboration with the over 4,000 Delta Dental of Washington member dentists throughout the state,” WDS said.
1. Washington State Dental Association. Dentists seek insurance commissioner review of Delta Dental reorganization. January 9, 2018. http://www.wsda.org/docs/librariesprovider52/private-library-washington/delta/final-wsda-oiccomplaint-press-statement.pdf?sfvrsn=2. Accessed January 23, 2018.
2. Pauley C, Delecki C, Larson B, et al. Time is right for OIC to reconsider Delta decision. January 9, 2018. http://www.wsda.org/news/blog/2018/01/09/time-is-right-for-oic-to-reconsider-delta-decision. Accessed January 23, 2018.
Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Sante Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at firstname.lastname@example.org or smilesofsantefe.com.
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