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Or, Birds of a Feather; etc. etc
By Darrell K. Pruitt; DDS
Introduction
Just a quick note while I’m working on other material. As anyone can see from reading Rabia Mughal’s DrBicuspid article, “Dentists or patients: Who should get the insurance check?” Delta Dental is simply a sleazy company that dentists should shun to protect their patients’ welfare.
http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=301436&wf=34
It is unethical to sign a contract with Delta Dental, and I will help Delta show you why. Here is a sample of Delta sleaze I intend to present:
Arlene Furlong on Delta Dental
On September 17, 2008, Arlene Furlong posted an article about Delta Dental on ADA News Online titled “Delta caps rates nationally for two networks.”
http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3218
Furlong writes:
“A contract provision that holds dentists to Delta’s maximum allowed fee for non-covered services will affect all of Delta’s Premier and Preferred Provider Organization participating dentists throughout the country by January 2011.″.
The Upshot
This means that if a Delta preferred provider wishes to make up for the profit lost from providing Delta customers 25% discounts on dentistry, which works out to over half the dentist’s pay after expenses are deducted, doing more cosmetic dentistry will no longer help keep the doors open. Delta, like a sleazy dentistry broker, is telling its providers that it will demand discounts on everything for its customers. Think about it. It is beyond unfair business practice. It is tyranny.
Invading the Dental Homes
And now, Mughal tells us that Delta Dental intends to break up dental homes – where patients enjoy the benefits of continuity of care from dentists they prefer. Why does Delta harm their clients like that?
Ari Adler, the communications administrator at Delta Dental of Indiana says it is a matter of dentists stealing something from the network:
“Direct reimbursement to out-of-network dentists is a problem because it allows them to enjoy the benefits provided by the network without following cost guidelines and quality control measures of the network”, [Adler] added.
Quality control; you mean like UnitedHealthcare’s Ingenix?
When one thinks about it, since dentists will only be paid half of what they are paid today, no matter what they do for dental patients, quality control could indeed become a new issue, just like the appearance of black-market dentistry.
My Beat
I will be covering quality control by dental consultants soon. Did you know that they have their own national organization? It is called the American Association of Dental Consultants (AADC). I bet you didn’t know this: Less than a year ago, Dr. Gordon Christiansen as well as Dr. John Luther, Senior Vice-President of the ADA, spoke at their annual convention in Scottsdale, Arizona. Delta Dental was Dr. John Luther’s employer before he came to work for the ADA. Hmm, I wonder?
Wait, there’s more: the AADC’s largest sustaining sponsor is UnitedHealthcare Dental. http://aadc.org/site/sponsors.php
The Ingenix Scandal
Have you heard of UnitedHealthcare’s company called Ingenix? New York Attorney General Andrew Cuomo caught Ingenix being creative with physicians’ FOIA-disclosable data for cost-control purposes (profit), and calling it quality control. Ingenix was marketing its professional number-cooking scheme to insurers across the nation before Cuomo saw through their deceit and recently demanded Ingenix to be dissolved.
Transparent Feudal Mechanisms
One can see that incest probably worked well for royalty in Europe until literacy and the free-market brought transparency to their self-perpetuating feudal machinations. I will be watching for a name and email address of an appropriate Delta Dental official to contact about Delta’s sleazy business practices. At some point in this thread (which I can keep active for years), I intend to make someone from Delta Internet-famous among dentists, just like Trajan King, CEO of Intelligent Dental Marketing. Suggestions from readers and subscribers are always appreciated. Please, no in-laws.
Assessment
It is time to come out and defend yourself in front of a hostile audience, you good ol’ boys from Delta Dental … or not. Your old command-and-control tricks don’t stand a chance in a transparent marketplace, and I will show you that silence is lame defense as well. Someone on your team is trapped. Please, let’s talk sooner than later.
Conclusion
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Filed under: Career Development, Ethics, Health Economics, Insurance Matters, Managed Care, Marketing & Advertising, Op-Editorials, Practice Management, Research & Development, Risk Management | Tagged: American Association of Dental Consultants, Andrew Cuomo, Ari Adler, Arlene Furlong, delta dental, Dr. Gordon Christiansen, Dr. John Luther, Ingenix, Intelligent Dental Marketing, PPMC, Rabia Mughal, Trajan King |
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A Word to the Wise …
More than two decades ago, as a young private practitioner, I cautioned my medical colleagues, and others, about United Healthcare and their ilk. These aggregators pursued their own interests; not the patient or medical provider – despite corporate protestations otherwise.
Unfortunately, I did not prevail, as this was well before the commercial Internet era; circa 1995. Neither did the private PPMC that I launched in 1999.
Later, as a Certified Financial Planner™, and licensed insurance agent, I could not stomach selling the financial, or insurance, products of the UHC Group or its subsidiaries. For example, “Golden Rule” plans were among the first commercial MSA/HSAs on the market. Initially fine and innovative, these tanked with the UHC purchase of GR, despite enthusiastically endorsing and personally using the high-deductible-health-plan concept.
Of course, the CPT® code – Igenix situation was well known to health insurance industry insiders and professional “coding-optimizers”; before it ever became the scandal it is today!
Ditto, the current financial meltdown on Wall Street, as a host of certification holders, and the many non-fiduciary “financial-advisors”, wealth-managers” and financial-consultants” who have finally demonstrated what they really are; salesmen and shills for the industry.
And so, going forward, I trust a word to the wise will be sufficient. But, if history is prologue, it won’t be!
Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief
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Easy PRey,
If the name Ari Adler sounds familiar, he is the Public Relations professional quoted in Mughal’s article. “Dentists or patients …” presented in the Introduction to this thread, “I will hurt you Delta Dental.” Mr. Adler is employed by Delta. He heads its Corporate and Public Affairs division. He is also an adjunct journalism/PR instructor at MI State University (from Twitter).
Mr. Adler’s website says: “I’m available for hire as a professional speaker and trainer for company meetings, conferences, workshops, etc. Presentation topics include public relations, media relations, and new media/social media.”
I wonder how well he handles Search Engine Optimization [SEO]. Let’s find out.
Adler’s latest comment “Hey, Big Brother, over here — the copy,” exposes the problem one must have maintaining personal transparency when one works for Big Brother as a day job, and runs a progressive blog at night. I can only imagine that it is difficult for traditional PR people to live in both worlds these days.
In the article, Adler asks this question shortly before requesting readers’ opinions about his social dilemma: “What should we be telling people looking to join us in the online universe? Is this like Big Brother watching everything we’re doing – only we’re some sort of insane masochists who volunteer to be watched?” I think the answer is, “Yes.” You didn’t volunteer, Ari Adler. You sold out. You are a hired gun.
Comparatively speaking, I am a free-lance amateur with wattage. It sort of makes me like the first shameless ham radio operator to show up in a polite, quiet, neighborhood – dressed in underwear and scratching.
I posted responses to three of his other questions below on his blog.
You’re learning hard lessons fast in the PR business, Ari Adler.
“If I make a bad pun or a risque comment on Twitter, and it’s been known to happen, should that impact how people treat me at work?”– Yes
“If a blog post I write is written specifically to provoke a discussion but someone who does business with my company disagrees, will that come back to haunt my employer?”
– Yes
“Please offer your opinions below — don’t make me write something provocative just to elicit a response. My boss might not like it.”– No, your boss will not like this.
http://www.drbicuspid.com/forum/tm.aspx?m=646
Let’s you and I discuss your thoughts about Delta Dental. How about it, Ari Adler? What do you really think of transparency?
Darrell K. Pruitt; DDS
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Equal Time Offering,
We ask all dentists – satisfied with any of the companies mentioned above – to post, comment, opine or otherwise contact us for a special investigative report; named or anonymous.
Thank You
Hope Hetico; RN, MHA
Managing Editor
770.448.0769
MarcinkoAdvisors@msn.com
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UHC
Mary Jerome was a professor at Columbia University who was diagnosed with ovarian cancer at age 46. She was met with crushing medical bills for “out of network” services that should have been reimbursed at higher rates by UHC.
As her personal finances began to bleed out, she was smart enough to make contacts with the sharks at the AG office who went right into attack mode. They were able to determine that indeed both the idea and the input of Ingenix database were both suspect and potentially criminal. Instead of dragging this out in court, UnitedHealthCare wisely chose to settle.
Video Link: http://www.msnbc.msn.com/id/21134540/vp/28635471#28635471
Ann
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UHG has just agreed to shut down its’ Ingenix database. Readers, please keep us posted.
Ann
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Advice for Delta leaders from below
A little over a week ago, Richard Edelman, CEO of Edelman, a global PR firm with a 57 year history, addressed the New Media Academic Summit at Georgetown University. The title of his presentation was “From PR to Public Engagement: The Opportunity for the Industry.”
Ironically, I learned about the lecture on Twitter from a Delta Dental public relations intern. It would do DDPA CEO Kim E. Volk good to view the Edelman’s presentation that her young, wide-eyed intern discovered.
I recognized the alert Delta intern’s grasp of modern communication in her appreciation of a significant address that was otherwise largely overlooked. But since I know about Delta’s level of business ethics, I cannot help but think the intern is excusably naïve about transparency and her boss. I’m fairly certain that Edelman has never lectured at the Kellogg School of Management, CEO Kim Volk’s alma mater. He’s much too progressive.
Sometimes it takes a naive generation and stupid questions to blissfully plow under stupid answers.
Edelman says that in an era of citizenship, ”People expect a relationship with companies and brands.” He acknowledges that there is mistrust in authority like never before. And that brings me to the very poor relationship I have with Delta Dental. I have no respect for Delta’s leaders because it is clear to me that their calculated policies harm my patients who happen to be their clients. I consider it my Hippocratic obligation to my patients to protect their welfare, and I confidently expect Delta Dental to ultimately surrender to our demands.
Months before I noticed the quickness, power and penetration of Twitter, I boasted “I own Delta.” Old school blogs by themselves make it easier than ever before for consumers to hold businesses accountable. For example, if one googlesearches “Kim E. Volk,” this thread is her third hit. That’s accountability. But that’s only scratching the surface. I can already tell that Thomas Friedman, author of “The World is Flat,” underestimated the efficiency of empowerment. Five years ago, he couldn’t have known about nuclear-powered Twitter.
Edelman points out that 90% of web traffic goes through search, and he also said that Twitter grew 1,382% in the last year. This means that there is less and less control of message because of more sources – causing an unpredictable flow of information. He recommended to the public relations audience to meet the demands head on by starting conversations about one’s company rather than ignoring customers. In advice that sounds like it was taken from the pages of “The Cluetrain Manifesto,” Edelman suggests “Help people come together in social network with opportunity for consumer generated content and feedback.” He adds, “Go where the people are. Don’t expect them to come to you.”
Even though I think this answer is probably appropriate for the corporate types he addressed, I think he presents PR from a limited perspective that takes control for granted. I would say, don’t MAKE them come to you.
In character with his presentation, in his final slide, Edelman congratulates David Weinberger and the 10 year anniversary of “The Cluetrain Manifesto.”
The list of 95 Theses featured in “Cluetrain“ is a prophetic piece. I recognize numbers 53 and 54 as truths which define a common management problem at Delta and countless other fat, protected businesses in the nation. “There are two conversations going on. One inside the company. One with the market. In most cases, neither conversation is going very well. Almost invariably, the cause of failure can be traced to obsolete notions of command and control.”
After a decade, Thesis number 82 finds its target as well “Your product broke. Why? We’d like to ask the guy who made it. Your corporate strategy makes no sense. We’d like to have a chat with your CEO. What do you mean she’s not in?” How prophetic is that?
There’s hope, though. The authors of “The Cluetrain Manifesto,” Rick Levine, Christopher Locke and Doc Searls – joining David Weinberger – offer hope the support of aged wisdom in Thesis number 84. “We know some people from your company. They’re pretty cool online. Do you have any more like that you’re hiding? Can they come out and play?” I think Delta should promote the intern to Volk’s job before corruption soils another fresh, innocent soul.
D. Kellus Pruitt; DDS
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