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Washington State Dental Association

Open Letter to WDS - John Barrett, DDS

The following is text of a letter I intended to send to WDS as a resignation statement. After some thought, I decided it would be better to post these comments in open forums such as this and restrict the resignation itself to the first line.

Open letter to Washington Dental Service:

I hereby submit my resignation as a member dentist effective June 13, 2011.

Washington Dental Service was once the leader in dental prepayment promoting better dental health and relationships among patients, purchasers and dentists in a way that insured the best dental care could be offered to patients throughout the State of Washington. When WDS was created in 1954, it was the very first dental prepayment company anywhere. Who could have predicted the amazing access to care that this organization would have created for so many people over the next three or four decades.

That leadership role has been abdicated apparently in the desire for WDS to grow financially and to become a bigger player in the game or perhaps just to save its existence. It appears that WDS will sell any scheme to any purchaser in order to hang on to or grow its book of business and it is very apparent in our offices that the patients’ and purchasers’ premiums, however cheap or expensive they may be, buy them very little in the way of dental health. Annual maximums are so low that they go almost nowhere for the patient who needs significant dental care whether the need is brought on by accident, genetic predisposition, neglect or other cause. The plans we see from WDS continue to shock us in the ways they have been degraded from the standards we used to expect. They have become strikingly similar to competitors’ schemes that member dentists, WDS board members and staff have always viewed as shoddy and uncaring about whether better dental health resulted from their activities.

The original relationship between providers and WDS utilizing a filed fee 90th percentile statistic was a stroke of genius on the part of WDS. This created a fee setting system that allowed the market place to function where each dentist could set his own fees within definable limits and simultaneously a check would be maintained against the inflationary influence of a third party pay system. A contract was forged between WDS and its providers under this system that was a hallmark of excellence and it worked well for decades.

Two years ago WDS unilaterally broke this contract with its member providers intimating that the fee freeze they put in place would be temporary. The following year WDS again abrogated its agreement freezing fees for a second time.

Now WDS is no longer satisfied with breaking the system and it now wants to lower all providers’ fees approximately 15%. No longer is there relationship between WDS and its providers that can in any sense be referred to as “Premier” or any other term of excellence. The PPO fee discount system WDS fell for a decade ago where members could opt in or out is no longer optional. It is now the norm. WDS no longer has anything better than this fee discount system that enables it to scramble for premiums from purchasers but does little to promote in any positive way, good dental service delivery or better dental outcomes for the end beneficiaries, the patients.

While it promises lower premiums to the purchaser and more patients to dentists who are WDS members, it certainly will not work for member dentists anymore because it creates a competition amongst all of them for the limited patient pool. Only some can win in this scheme. If almost all Washington State dentists are members (and they are), WDS cannot deliver on the promise that by agreeing to a 15% fee discount, members will all get a larger share of the patient flow and can somehow make up losses by delivering more services. It is an empty promise and will result in closure of dental offices and lowering of quality of services.

I believe that for the past ten to fifteen years dental prepayment is becoming increasingly less relevant. The benefits have continued to be watered down with such schemes as annual maximums, “duplication of benefit” limitations and other methods of reducing the coverage for services that the plans would appear to cover to the average patient reading the benefits booklets. WDS now promotes a system of plans that tend to create an expectation of coverage for the patient that is unrealistic. At time of service and sometimes not until time of denial of payment by WDS, the patient and the provider learn that the plan does not pay for the expectation of coverage created in the plan booklet. One of the insidious side effects of this practice of selling plans that do not deliver what they seem to promise is that the dentist can easily be portrayed as the bad guy, charging too much for services. WDS in the past offered few enough different plans to sell to purchasers and they were well enough known amongst members that it was not difficult to educate patients about coverages and limitations of their policies. Additionally, WDS plans were consistently higher quality, more transparent plans that delivered what was promised. Now it seems every policy is different and some are so poor that denials and limitations spring up like weeds.

Portions of this comment have been editorially deleted.

-John Barrett, DDS Member Board of Trustees 1979-1995 Member Board of Directors 1983-1993 WDS Board Chairman 1985-1987

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