Live Chat
Washington State Dental Association

Delta Initiative: What It Is & What It Isn't

Read the following piece, originally published in the July issue of the WSDA News, to learn more about the current Delta Initiative. Also, be sure to mark your calendars for Delta's special meetings, being held Wednesday, September 6 at 2 p.m. at the Lynnwood Convention Center. Learn more at wsda.org/delta.

When the WSDA recently orchestrated an information session at the PNDC to discuss Washington Dental Service/Delta Dental of Washington (Delta), there was considerable dialogue about what we could and should say in advance of the meeting, and what we could not. We didn’t want to play our hand, nor did we want to suggest that reimbursement rates would be discussed. 

The power of antitrust laws
Antitrust laws expressly forbid discussions and activities that could result in agreements or concerted actions among WSDA members or other licensed dentists that could be seen as unlawfully restraining competition.* 

As such, this initiative is not about reimbursement rates or collectively taking action against Delta. Instead, this initiative is focused on patients, and specifically, the harm Delta’s actions and lack of transparency are inflicting on patient care. The WSDA is committed to finding an innovative solution to these problems and has steadfastly examined ways to create change from within, using Delta’s own bylaws and rules to help institute governance changes that will give Delta member dentists a greater role and voice in Delta and put Delta’s focus back on patient care.

To that end, the WSDA enlisted Hall, Render, Killian, Heath & Lyman to draft bylaws amendments that would allow Delta member dentists to influence change from within Delta. 

The strategy behind bylaws amendments
If approved, the bylaws amendments will substantially change the way Delta conducts itself in the areas of patient care, transparency, and governance. Not only will the proposed amendments benefit patients, but by modifying current rules regarding the Board of Directors, changes would give dentists in Washington a seat at the table they’re currently denied. We think it’s important to make sure we have a voice in all future decisions made by the Delta board. 

Patient Care Amendments

Loss ratio requirement
This amendment would require Delta to implement a 94 percent loss ratio, meaning that 94 percent of all revenues collected by Delta must be spent on patient care. If Delta does not spend 94 percent of premiums on patient care in a fiscal year, it will be required to issue refunds to its policyholders in an amount necessary to achieve the 94 percent loss ratio. Employee compensation, advertising, donations, advocacy, and all other expenses that are not related to patient care will be capped at 6 percent of total revenue.

Independent review process
This amendment would compel the Delta Board of Directors to make Delta cooperate with the Office of the Insurance Commissioner to implement an independent review board for standalone dental insurance plans. This independent review process will require Delta to have a comprehensive grievance and appeal process, allow an independent organization to hear disputes related to decisions made by carriers, and require a written utilization review criteria based on reasonable medical evidence.

Vote requirement
The final patient care-based amendment would require the Delta Board of Directors to vote on all recommendations made by the Member Advisory Council. These votes will have to be made public to the general membership.
Transparency Amendments

Transparency Amendments

Administrative expenses
This amendment would require Delta to disclose its administrative expenses by category, as well as detailed financial statements of all affiliated entities, including corporate contributions to its foundation and how these contributions are used, particularly regarding lobbying and commercial advertising.

Claim denials and review
This amendment would require Delta to disclose the percentage of claims denied and, of those, the percentage reviewed by a licensed dentist in making the denial decision.

Corporate records
This amendment would require Delta to make corporate records, including Board of Directors and all committee meetings minutes, available to Delta members for their review consistent with state law.

Governance Amendments

Definition of an Independent Director
This amendment would modify the Delta bylaws’ definition of an independent director. Currently, Delta has included several stipulations around the qualifications that make a director “independent” beyond those that are required by the IRS. Our amendment simply redefines independent director to align with the instructions set forth in IRS Form 990. This would allow someone with a dental degree, but without a financial interest in Delta to serve as an independent director. 

Governance and Nominating Committee
This amendment would eliminate the requirement that independent directors constitute the majority of the Governance and Nominating Committee.

President and CEO Board provision
This amendment would remove the provision that the President and CEO is automatically a member of the board without a vote of the Delta members.

Director nominations
This amendment would provide new opportunities for Delta members to nominate individuals to serve as directors of the corporation.

Contested elections
This amendment would provide new opportunities for Delta members to nominate individuals to serve as directors of the corporation.
 
*This includes discussing reimbursement rates, pricing, fee schedules, or other competitively sensitive information. It also includes making any agreements not to deal with Delta or otherwise boycott Delta.

Posted: / Last Updated: