The Delta Dental Plans Association comprises 39 allegedly independent Delta Dental member companies nationally. Their various dental plans cover approximately one-third of our country’s population. Most of the companies are 501c nonprofit entities. Others are spinoff for-profit insurance companies. The full autonomy of these companies may be questioned, though, as many supposedly independent Delta Dental groups are partners in various for-profit business ventures.
The inception of Delta Dental goes back to the mid-1950s and 1960s. Dentists collaborated to establish nonprofit insurance companies to increase the public’s access to dental services. Initially, member dentists ran Delta Dental.
Today, operational control of the various Delta Dental groups has been largely removed from dentist membership. Most authority rests in the hands of a variety of corporate officers and directors, few of whom are doctors. Salaries for senior managers of these nonprofits are generally well into six figures and often several million dollars annually.
As one might expect, friction has grown between doctors, who formerly controlled these largely nonprofit insurance providers, and current management. Conflict has centered upon management’s reductions in dollars paid under fee schedules, reduced scheduled benefits for patients, operation with allegedly exploitive medical loss ratios (dental loss ratios or DLRs), lack of transparency in company operations and investments, loss of control by member dentists, and allegedly unfair claims review processes
One of the more notable disputes was the legal battle in Massachusetts to remove a 5% withholding fee from Delta Dental Premier billings. The Commonwealth’s Division of Insurance (DOI) overturned the 5% withholding in 2009.
Interestingly, former officers of the Massachusetts Dental Society (MDS) were very active in support of the DOI’s ruling to overturn the Delta Dental withholding. By contrast, current ADA executive director Dr. Kathleen O’Loughlin, president and CEO of Delta Dental of Massachusetts from 2001 to 2006, was then in support of her insurance company’s withholding.
More recently, the California Dental Association, the Washington State Dental Association (WSDA), and the Massachusetts Dentists Alliance (MDA) have also legally challenged operations of their respective states’ incarnations of Delta Dental. In distinct juxtaposition, in numbers of other states, and with numbers of other elements of organized dentistry, we see little to no confrontation of Delta Dental. One is left to speculate why certain dentists’ groups elect to openly challenge Delta Dental’s activities while others either cooperate or capitulate.
Concerned Dentists of Washington State
The Concerned Dentists of Washington State (CDWS) has been a leading advocate for significant changes in the business operation and direction of Dental Service of Washington (doing business as Delta Dental of Washington or DDW). This spearhead group has also prompted the WSDA to further take up the campaign.
CDWS has focused on regaining control of DDW for member dentists from an elite few nondentist managers who have allegedly usurped governance of the nonprofit insurance company. As early as 2011, CDWS established dentists’ rights of proxy votes. This meant that whenever an annual meeting was held, even during a doctor’s busy workday, their voting rights would be honored.
Also established was the requirement of annual meetings that could uphold or amend DDW’s company bylaws. DDW decided to cancel annual meetings required under company bylaws for 2017 and 2018. Legal pressure from CDWS and WSDA forced a special meeting on November 15, 2018, at the Double Tree by Hilton Seattle Airport Hotel.
DDW bylaws under the heading of “SECTION 1. ANNUAL MEETINGS” specifically read “An annual meeting of the members of the corporation shall be held on the second Friday in November and at a time designated by the Board, the Chair or the President and CEO. If the Board determines that for good cause, the meeting cannot be held on the second Friday in November, the meeting shall be held as soon thereafter as practicable.”
“Just two weeks prior to the Annual Membership meeting in 2017, I called the hotel where the room was being rented by DDW and was told that a deposit had not been paid to reserve the room for DDW,” said CDWS director Dr. Kalman Klass of Seattle.
“I called the DDW president, Jerry Phipps, and asked why. He responded that they decided to not have the annual meeting. They gave absolutely no notice to members or the state dental association,” Klass continued.
“He got very short with me on the phone when I politely informed him that this was a day scheduled already by member dentists to cancel their day with patients and for the WSDA to plan their own room rental for the meeting,” Klass said.
“I then called the executive director of the WSDA, Bracken Killpack, and I believe he met with their own attorneys the next day to discuss what to do. To add insult to injury, DDW also cancelled their annual meeting for 2018 as well, which is one reason why we called for a special meeting to amend more bylaws,” Klass said.
Under the heading of “SECTION 5. PARLIAMENTARY PROCEDURE” in the DDW bylaws, “Meetings of the members of the corporation shall be governed by parliamentary procedure as set forth in the current edition of Robert’s Rules of Order.”
“Since they (DDW) blatantly disregarded Robert’s Rules of Order during our very first special meeting in 2017, we pushed through a request to allow in a parliamentarian and our attorney for all meetings, beginning last year,” Klass said.
“DDW videotapes all of our meetings. We requested a copy from last year. In summary to this request, they have refused to provide us a copy of any videotape from any meeting whatsoever,” Klass added.
“At the special meeting a couple weeks ago, we again asked when to expect a copy of the videotaped meeting from over a year ago, and they responded that they do not know when it could be provided. I think what they were saying was that we would have to litigate to get a copy of any videotape. No surprises there,” Klass said.
In attendance for the 2018 DDW special meeting were both an attorney and parliamentarian representing CDWS, in addition to DDW member dentists. DDW and its directors had their chief legal counsel in attendance, plus an additional two attorneys from the law firm of Perkins Coie. The extremely high-profile law firm has represented clients such as Google, Facebook, Barack Obama, the Democratic National Committee, and Hillary Clinton.
We asked DDW for comment, but it has not responded to our requests.
The Massachusetts Dental Society
The current MDS leadership has a vastly different approach to dealing with Dental Service of Massachusetts (doing business as Delta Dental Massachusetts or DDM) compared to its predecessors. As noted earlier, former leadership of the MDS had a protracted legal battle with DSM over a 5% withholding on doctors’ billings that the Massachusetts’ DOI finally rescinded in 2009.
Contemporary leadership of the MDS recently negotiated to accept an approximate 9% cut to Delta Premier provider fees. This was seemingly a done deal until the Massachusetts Dentists Alliance presented a challenge to the Commonwealth’s DOI. The president of the MDS has gone to great lengths in attempts to validate the group’s decision to compromise. Others may see the deal more as possible capitulation.
More recently, one major negotiator for the MDS with DDM had his oral surgery office featured in DDM’s marketing newsletter to dentists, The Chatter. A November 2018 online article, “Three Ways to Effectively Manage Your Dental Practice,” highlighted practice management tips from the oral surgery practice of Dr. David P. Lustbader, owner of South Shore Oral Surgery. Lustbader is the immediate past-president of the MDS. He and the MDS don’t seem very concerned over a possible appearance of a conflict of interest. Earlier this year, DDM president Dennis Leonard also interviewed Lustbader in a Facebook Live post relating to dentistry’s role in the opiate crisis.
DDM and its for-profit subordinate company, DentaQuest, have joined with the MDS in sponsorship with the Boston Red Sox in support of TeamSmile, a national charitable effort to get mobile dental units to disadvantaged children. The lead dentist on this project, as indicated in marketing material presented to the public, is current MDS house speaker Dr. Raymond K. Martin, who was also a former president of the MDS. He runs a general dental practice in Mansfield, Massachusetts.
It’s abundantly clear that CDWS has the support of the WSDA. Both entities are willing to cooperate to address alleged abuses in the insurance industry. Some criticism of DDW president and CEO James Dwyer has been very pointed. The gloves are off, and this seems like a tooth-and-nail struggle. Dentists are in what they deem to be a fight to save their profession, the doctor/patient relationship, and ethical practices within the insurance industry.
The MDS has taken a different tack. Its leadership is definitely not the confrontational and fully transparent group of a decade earlier, as elucidated in a 2017 article by ADA News. Dr. Jill Tanzi, a director with the MDA, said she was under the impression that the MDS supported the MDA’s efforts.
“It’d be nice to work together, to stick together and not cause any conflict,” Tanzi told the ADA. “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.”
MDS executive director Dr. Robert Boose, a nondentist with a doctorate in education, countered Tanzi’s opinion for the ADA.
“While the Massachusetts Dental Society is not involved with the recent petition group (MDA), 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 Boose.
“The society has been involved in an ongoing dialogue with the attorney general. 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,” Boose said.
“It’s a redundant exercise,” Boose said of the petition. “They’re asking for something we already asked for. Unfortunately, this is an extensive process.”
It’s seemingly today a valid position to assume that the insurance industry has nearly totally won its battle against healthcare. Whatever bones it throws to patients, the public, or providers in terms of charitable activities or sponsorships are at the cost of patient benefits and provider remunerations. Coopting of healthcare’s leadership simply assists in “herding the sheep.”
It would be naïve to assume that leadership in organized dentistry hasn’t examined the rapid demise of the American Medical Association. There exists little incentive for physicians to join an organization that has failed to protect patients from the insurance industry and corporate medicine. As such, the ADA is desperately attempting to stabilize membership losses. Is that being done via meaningful challenges to abusers of the doctor/patient relationship or membership drives with little significance beyond a booze party or pep rally?
So, what can be said of dentistry’s leadership? Are they self-serving practitioners attempting to use positions in authority to market their practices? Are they too often seeking future compensation and/or considerations from the insurance industry? Are they attempting to “get theirs” before dentistry’s well runs dry? Some are, while some are not.
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way—in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.” —Charles Dickens, A Tale of Two Cities.
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 Santa 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 email@example.com or smilesofsantafe.com.