A New Survey on Dental Insurance

Come on out Kim E. Volk – CEO of Delta Dental

By Darrell K. Pruitt; DDS

Today, Julie Frey posted “Dentist & Dental Insurance: No Love Lost” on Jim Du Molin’s Blog.

http://www.thewealthydentist.com/blog/1186/dentist-dental-insurance/

Frey hosts dentists’ frank criticism of dental insurance – their harsh sentiments backed up with fresh results from yet another of the blog’s timely studies that nobody else can compete with. Frey writes “Half of dentists have mostly or completely stopped accepting dental insurances, according to this survey.”  One dentist captured the mood of the dentists with the statement, “Do the math … somebody is making hell of a lot of money on these plans, and it is not the dentist!” I smelled blood and posted the following comment.

Bloody Sunday

Anonymous members of the obscure National Association of Dental Plans (NADP) are losing the fat, collective thumb they once oppressed us with – even using our own ADA News to present their non-negotiable terms. Apart from common sense appearing in the marketplace about the same time as transparency, multiple other interconnected factors are causing dental insurance companies to lose business. The bad economy, corporate greed and pride are a few of their more serious handicaps that come to mind. Wasteful, deceptive insurance practices have aggravated my patients and me for decades before modern networked recourse became available on the Internet through progressive Websites like Jim Du Molin’s Blog. I’ll go out on a limb and say it is not unprofessional for us to enjoy protecting those we serve by showing no mercy to unfair stakeholders like the NADP.

There. I said it. In fact, as US citizens and taxpayers I think blowing the whistle on unneeded expense and danger in the nation’s healthcare delivery is the least we can do for meaningful healthcare reform. I say do your part. Make an insurance CEO like Delta Dental Plans Association’s Kim E. Volk feel discomfort on the Internet. Do you know that Kim E. Volk is the only person who has ever refused to accept me as a friend on Facebook?

http://www.jbpub.com/catalog/9780763733421/

Assessment 

We really don’t want to allow Delta Dental, UnitedHealthcare, United Concordia and others to dictate fees for non-covered dental services, do we? I also don’t think they deserve continued protection from FTC anti-trust litigation. I say we punish the NADP hard every chance we get until the repeal of the McCarran-Ferguson Act and finally make such in-your-face collusion illegal for crying out loud.

Conclusion

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13 Responses

  1. Really informative post; I always spread your message. Looking forward to an update. For too long now have I had the need to begin with my own dental blog. Guess if I wait any more I will never ever take action. I’ll be sure to add you to my Blogroll.

    Thanks again!
    Melisa V. Lisky; DDS
    [Watertown Cosmetic Dentist]

    Like

  2. Surviving the tough times

    As a businessman, I’ll tell you something you probably already know. It’s tough out here.

    In the last two months, my practice has slowed considerably and I know that I’m not alone. Sometimes it’s scary…. But I’ll make it through this. I always do.

    I know dentists. Very few will admit that their business is down other than to family and close friends. Quite frankly, even though I’m about 98% more transparent about my feelings than other dentists, it nevertheless puts my nerves a little on edge to mention that the down economy affects my business. But then I’ve gotten into the habit of writing about the things that bother me. Besides only my friends read my stuff anyway.

    I’m not in a terrible position. It’s just uncomfortable. This is one of those risks a business owner accepts in the land of the free. It’s accountability in the bad times as well as the good that makes a business strong. I’ll be OK. Unfortunately, I’ve had to cut back the hours for my employees who also depend on my practice. That increases the discomfort.

    Dentistry occupies a unique niche in business that is difficult for stakeholders to discount while looking intelligent. Performing dental procedures involves intricate handwork in an unpredictable environment to precise tolerances without harming the client. In addition, most clients can tell good dentistry from bad generally by the way it feels while it is being done as well as weeks afterward. It stands to reason that up to a point, the more the dentist tries to do in ever shorter allotted time (in the same way family physicians are currently squeezed by stakeholders wanting their cut of healthcare dollars), the more the quality drops and the longer the waits in waiting rooms.

    I’m fortunate to be a dentist because I enjoy unrushed, intricate work as well as personal relationships I’ve built with my loyal patients over decades of providing them the best care I can. I welcome the competition of a free and fair market. It makes me try that much harder to please those who trust me. If the government and/or insurers don’t completely take over dentistry using HIPAA for leverage against all healthcare providers, business is bound to get better again for traditional dentists like me. I’m thankful that everything in my practice is paid off. I’d hate be starting out in this economy with $100,000 of school debt even before buying a dental chair. It is the financially-stressed dentists who can quietly succumb to trying to do too much too fast. Sadly, Medicaid patients rarely have a choice of dentists.

    When a provider reliably receives new patients every day from insurance or the government rather than from referrals by satisfied customers, ethics becomes a test that at least some new dentists will fail, and a bad grade on their yet to be revealed report card has real consequences these days. As unfairly as it sounds, it will be the young and naïve dentists who are most likely to sign up to treat Medicaid patients for fees that rarely cover overhead – unless one does a lot of fast work in a tight schedule. Do you see what I mean? Adam Smith, the father of economics, knew a thing or two about the market-cleansing effect of “invisible hand” of competition and managed care dentistry, didn’t he?

    Here is the ADA/TDA-approved crime that harms patients nation wide: Since the profession’s leaders refuse to discuss politically incorrect but critical issues with members, very few dentists who apply for an NPI number and sign up for Medicaid are aware that dentists are being graded according to the claims they submit electronically. What’s more, the grades the uninformed dentists receive so soon out of school will follow them throughout their careers. In a year or two when Pay for Performance comes into effect, dentists’ life’s earnings will be artificially pushed downward – saving stakeholders money. Whether these savings will end up in the patients’ pockets is doubtful. Nevertheless, this is part of the “quality assurance” that was written into the HIPAA law by healthcare stakeholders who had votes to win or goodies to sell… or vice-versa.

    As many of you have witnessed in the last few weeks, Mary Kay Linn, the Executive Director of the TDA simply refuses to discuss the threat of HIPAA with this TDA member. Ms. Linn is only one of several leaders who have consistently failed to properly represent the interests of dental patients in Texas. That might be you.

    In addition to the fact that many young dentists will be tagged by CMS as over-diagnosing decay according to proprietary algorithms – which may be true – the comparatively poor longevity of the restorations will also be uncovered through data-mining regardless of the quality of the dentist’s work – which may be true as well for reasons beyond the providers’ control. It is well documented that many poor families not only lack the education in proper oral hygiene, but their kids consume more refined sugar than children from higher income levels. That fact about society around the world skews the curve against the interests of dentists who accept Medicaid as well as their patients. Yet Mary Kay Linn, the Executive Director of the Texas Dental Association won’t discuss it with dentists who pay her salary.

    For many years it has been the intention of HHS to establish quality ratings for all healthcare providers in the nation. Secretary Michael Leavitt told the 2006 ADA House of Delegates that if they don’t define quality in dentistry, his MBAs will. So at a time in history that leaders of the ADA are frozen in fear because of bad decisions that were made long ago, Leavitt’s family owns one of the largest insurance firms in Utah. Michael Leavitt’s family knows a lot of MBAs. Two years later, President Bush promoted quality assessment in healthcare as part of his executive order. He often liked ideas he knew nothing about simply because there were those in his cabinet who failed to tell the man the truth.

    Let’s forget that until recently, irreversible alterations of a person’s mouth required the hands of a licensed professional with a four-year post graduate degree in addition to continuing education that lasts one’s entire career. For the sake of argument, let’s pretend that the states cut down the education requirements to two years of post-graduate education, or even two year junior college course following high school – or even no licensure at all. Will that cause the price of dentistry to fall? Yes it will. Will Americans still spend more on dentistry? Yes, again and again in painful ways.

    If you are looking for a new dentist, would you trust Obama’s friends to determine the best dentist for you and your family? Control of doctor-patient relationships seems to have become a bi-partisan goal, and politicians are using electronic health records and the ADA Department of Dental Informatics to make it happen.

    D. Kellus Pruitt DDS

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  3. The business end of transparency

    Fore those who missed yesterday’s premier, I’ve ambushed Delta Dental’s newest spokesman. As sports fans’ luck would have it, Mr. Adrienne Lew is a newbie in the frontier… and he’s all alone.

    Hope you enjoy this.
    ________________________________________
    From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
    Sent: Saturday, October 02, 2010 4:20 PM
    To: ‘alew@delta.org’
    Subject: The business end of transparency II

    Dear Adrienne Lew – Community Contact for Delta Dental:

    First of all, let me commend Delta Dental for finally providing a responsive contact to handle dentists’ and patients’ questions and complaints. I praise it as a brave step toward unprecedented transparency in the dental benefits industry that I hope BCBSTX, UnitedHealth and other NADP (National Association of Dental Plans) members will adopt as well. After all, you simply must agree that accountability to those who have no real choice but to use your preferred provider lists is only fair in the land of the free. Anything less is tyranny, Mr. Lew. And that would be against the law for several reasons. So let’s you and I strive to keep this portal open.

    Relax. You don’t have to do a thing. I know the neighborhood well and I’ll carefully walk you and the highest executives of Delta Dental through the community whether you respond or not. Besides, it’s my opinion that “Community Contact’ promises to improve Delta’s notoriously poor service, and everyone knows Delta desperately needs help right now. Not disappointed customers.

    Forget about angry dentists. For the sake of dentists’ incredibly loyal patients who can quickly turn into informed, angry and loud Delta Dental customers, I wish you luck handling nimble, unconventional PR tricks you’ll never learn from veteran Delta PR expert and spokesman, Mr. Ari Adler – even though he teaches public relations at MSU. What I offer is refreshing, consumer-friendly and politically-incorrect orneriness.

    You might as well relax. There’s no turning back now. Eight or nine of my friends and a couple of relatives are following us and this time, the FTC can’t be counted on to do a thing to stop the seepage of truth. Like other PR types I’ve confronted, you can try to hurt me by filing a complaint with the Texas Dental Association, but I should warn that there’s already a 3-year backlog that hasn’t been touched. All are from the TDA for saying bad things about the TDA “and/or staff.” Need I say more?

    Someone just has to say something about Delta Dental officials’ carelessness. If not me, who? And if not now, when?

    ADA officials have proven to be incapable of protecting dental patients from Delta Dental’s predatory business practices in part because the McCarran-Ferguson Act of 1945 unfairly shields Delta Dental officials and other NADP members – who meet regularly to discuss the dental industry – from the scrutiny of the FTC for violating the Sherman Anti-Trust Act. However, since ADA officials who also meet regularly to discuss the dental industry, have no such protection from FTC investigations, the uneven application of federal law allows the NADP to leverage their power over third-party dentists to steal from the dental care of their unsuspecting clients.

    It is well-known but not publicly admitted by ADA officials that if they do their jobs to the best of their abilities and succeed in properly representing patients’ interests against the interests of NADP members who take the patients’ money, a brutal FTC investigation of the ADA will surely follow. That is why ADA officials have appeared to silently tolerate Delta Dental’s tyranny for decades. They are powerless simply because they are ADA officials. Since I’m not an ADA official, I still enjoy the right to complain like any other American.

    I bet until you read this email, you had no idea that these days, one dissatisfied and vocal dentist has more power over Delta Dental than the largest dental organization in the nation. As an individual who always works alone, the Sherman Anti-Trust Act can’t touch me. I can discuss taboo issues critical to providing economical and safe dental treatment that the impotent ADA cannot.

    I’m looking forward to clearing up a few long-term issues with or without your help, Adrienne Lew.

    I’ll be back soon. You don’t have to do a thing. I’ve got you covered. Just sit there.

    D. Kellus Pruitt DDS

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  4. Driving wedges between Delta and the ADA

    Because of the unspoken job security consideration of Delta Dental’s revolving door relationship with ADA Headquarters over the years, ADA officials harbor special bias towards the sleazy company. As a matter of fact, 14 months after ADA Executive Director Dr. James Bramson was suddenly fired for reasons still kept secret from the members who funded his severance pay, former Delta executive Dr. Kathleen T. O’Loughlin was hired to replace him. Delta runs deep in the ADA. The editors of the ADA News have favored the unaccountable parasite for a decade or more.

    Another former Delta executive, Dr. John R. Luther, was hired on as a Senior Executive around 2003 to promote adoption of electronic dental records and HIPAA. He once told me that if his talking points and CMS links didn’t answer my questions about HIPAA then I should “write a letter to the editor of the JADA.” What a Delta-jerk.

    What goes around comes around – if slowly.

    The rumor is, 2 to 3 years ago when Dr. Luther failed to deliver on his EDR promises to the ADA in part because of his Delta Dental respect for ADA members, he was quietly sent off to be recycled – probably by Delta Dental. It’s hard to know who replaced him because the ADA has learned to be much more secretive about his Department of Dental Informatics than they were in 2006 when I first started pestering them for answers. I say the chances are 40:60 that Luther was replaced by someone with Delta Dental experience. And today I hear that the sleazy dental benefits company is planning opening clinics in Washington State!

    http://thedentalwarrior.com/2011/04/30/damn-the-torpedoes-full-speed-ahead-washington-dentists/

    How can ADA leadership possibly protect clueless Washington patients from a powerful, vertical discount dentistry brokerage system when Chicago Headquarters is the fulminating vector of rot? I cannot understand why more dentists aren’t speaking up as the Hippocratic thing to do. Image is superficial. Only honesty is professional.

    D. Kellus Pruitt DDS

    Like

  5. Resign Now – Jim Dwyer

    A week ago, the CEO of Washington Dental Service (Delta Dental) suggested that Delta dentists should work harder to make up for the 15% cut in pay. Now he regrets it. His apology was posted on Washington Dental Service Network Dentists Facebook:

    Message from Jim Dwyer – CEO:

    You may have seen the KING TV news report on May 10, 2012 about Washington Dental Service. I can certainly understand that my comments may have upset some member dentists. Please know that the clips of me were taken from a highly edited interview. Working more hours is one of many strategies dentists are employing to cope with a changing market place and the depressed economy.

    I respect and value our member dentists, and I know they are dedicated to providing quality care for their patients. I apologize for the context of the statement.

    Jim Dwyer

    ————————————-

    On behalf of its member dentists, WSDA posted the following comment on King 5’s page referencing this story:

    http://www.wsda.org/headlines/2012/5/15/follow-up-to-king-5s-news-story-on-wds.html

    Mr. Dwyer’s comments that dentists should “start working five days a week” to make up for the reduction in reimbursement were outrageous and disrespectful, displaying ignorance on what it takes to run a dental practice.

    In addition to seeing patients, most dentists spend many hours managing the administrative responsibilities of owning a small business and work to stay current with the technical and scientific advancements in dentistry. We are disappointed that the CEO of the largest non-profit dental insurance company in the State doesn’t understand these basic fundamentals of operating a dental practice.

    -Washington State Dental Association

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  6. Dentists respond negatively to apology from Washington Dental Service CEO

    James Dwyer, CEO of Washington Dental Service (Delta Dental), may well be the most hated person in dentistry today.

    He’s collected 23 responses to his apology to Washington dentists for telling them they must work harder because of Delta’s 15% cut in pay, and not one of them is nice.

    Darrell K. Pruitt DDS

    Like

  7. DrBicuspid notes Dwyer’s blunder

    James Dwyer’s blunder was picked up by DrBicuspid.com a few minutes ago. In features editor Donna Domino’s “Dentists up in arms over WDS CEO comments,” she goes more in depth in describing Delta Dental’s greed in the Northwest.

    http://www.drbicuspid.com/index.aspx?Sec=sup&sub=pmt&pag=dis&ItemID=310591&wf=47

    WSDA president Dr. Rod Wentworth tells DrBicuspid that in areas like Olympia, where state employees with WDS coverage can make up about 90% of a dentist’s patient base, practitioners cannot remain solvent. “Until the rate cuts, dentists were willing to take the hit — especially when they were longtime patients — and patients were willing to pay more to go out of network.

    After the cuts, it’s really hurt those patients, because they’re being squeezed to break their relationship with their dentist to instead go to a member dentist. I think it’s hurt the doctor/patient relationship.”

    Delta Dental has never respected doctor/patient relationships.

    Darrell K. Pruitt DDS

    Like

  8. Darrell

    You said above: Delta Dental has never respected doctor/patient relationships.

    Of course it hasn’t – it’s an insurance company.

    Anika

    Like

  9. Anika and Darrell,

    I am a doctor; not a dentist. But, there is a metaphor here for all medical professionals and health insurance companies.

    D.O.

    Like

  10. No News Here

    Nothing new to report here, boys and girls. Just move on.

    Dolly

    Like

  11. Dentists’ 1st Amendment rights

    Dr. Bob Gauthier, a Massachusetts dentist responded to criticism of Delta Dental on Linkedin by advising a hands-off approach. He means well.

    http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&discussionID=116077405&gid=2442267&commentID=81299741&goback=%2Eamf_2442267_175041914&trk=NUS_DISC_Q-subject#commentID_81299741

    Dr. Bob Gauthier:

    I can understand the feelings in these posts and I think the greed of all Delta Dental chapters is pervasive. It blows my mind that CEO’s with less education than the average dentist can be so condescending. Please watch how and what you post, antitrust laws are in play and dentists have been on the hook for suggestive remarks in the past. At the ADA’s website there is a free “antitrust” primer you should all read. Just trying to keep my fellow dentists out of trouble and jail.

    My response:

    Since I’m not an ADA member, I’m unable to read the anti-trust primer you suggested, Bob.

    By warning ADA members that they risk FTC investigations should they openly criticize Delta Dental officials, the ADA is arguably an accomplice in allowing WDS CEO Jim Dwyer to harm far too many of Washington state’s dental patients for far too long.

    Jim Dwyer’s ethics are so pitiful that if he were in any field other than the notoriously unaccountable discount dentistry business, transparency would have ended the man’s career long ago for natural, competitive reasons. On the other hand, I confidently express opinions without fear of retribution. I’ve been doing so for years. Can you?

    Don’t get me wrong. I think it’s wise to warn dentists to steer well clear of anti-trust violations, and I would never suggest entering into any conspiratorial agreements with other dentists. The FTC justifiably spanks dentists hard for collusion. On the other hand, a dentist acting independently is one person short of the minimum number needed for a conspiracy, and can never be charged with price fixing.

    The anti-trust laws you warn about simply do not apply to individuals expressing their opinions – and thank goodness! It would be counter to the tenets of the Hippocratic Oath if transparency were discouraged just to protect the reputations of Delta Dental CEOs. Regardless what the ADA primer says, Americas don’t relinquish their right to free speech when licensed to practice dentistry. Perhaps it’s only dentists who join the ADA who lose their right to complain. After all, ADA members employ registered lobbyists. I don’t.

    Trust me. I’ve been publicly demanding accountability from dental care stakeholders including Delta Dental for years, and I’m not anonymous. If openly criticizing Delta, BCBSTX or even the US Department of HHS could get a dentist thrown in jail, I wouldn’t be currently enjoying freedoms guaranteed in the Bill of Rights.

    God bless America.

    D. Kellus Pruitt DDS

    Like

  12. Dr. Gauthier responds

    Massachusetts dentist Dr. Bob Gauthier responds again to my challenging comments on the Dental Economics Linkedin group discussion, “Resign now, Jim Dwyer.” Bob is a good man. One rarely witnesses such openness from ADA members:

    http://www.linkedin.com/groupItem?view=&gid=2442267&item=ANET%3AS%3A116077405&commentID=81381774&trk=NUS_RITM-title#commentID_81381774

    —————

    Dr. Bob Gauthier:

    You are fired up, and rightfully so, but please don’t direct your frustration toward me! I’m not the bad guy here. Don’t get me wrong Darrell, I’m with you! I’m not talking about open criticism and debate at all, nor was this a scare tactic. I’ve just had a lot of experience with this stuff and understand the FTC and AT law very well. Here in MA we are having to deal with very similar issues. We’ve been working hard with members of our state senate and house to bring a “non covered services” law into to state. This will not allow third party payers to set fees on “non covered” services. We’ve also brought Delta of MA to the commissioner of insurance in this state and had demonstrated that their fee methodology was fundamentally unfair to dentists and the division of insurance made Delta of MA devise a new and more fare methodology which was enacted in 2011. We’ve been in high level discussions with State Senators, Reps, MDS officers, as well as Delta of MA, CEO. I understand the subject of free speech as well as the AT laws VERY WELL. Clearly I believe in free speech and have used my speech to effect change in my area even when my views are much to the right of the majority in my state. AT laws are not just about price fixing! And YES dentists have been prosecuted for “exchanging ( ) ideas” (you fill in the blank). All I’m saying is remember that the internet has a large audience and be sure to keep these tenants in mind while posting. I’m not a big ADA guy, though I am an active member because I believe that my voice can be heard to effect change with them more than it can without them. Yes, I am on your side I applaud your bringing this topic to the national stage and we all need to advocate for our profession, but we need to do it safely to be effective.

    My reply:

    Sorry if I seemed uncivil, Bob. In my wholly independent 6 year personal struggle to bring more transparency to the dental industry, I’ve acquired a habit of speaking bluntly because it almost always saves time.

    You are indeed not the bad guy here. For one thing, bad guys never respond, and for that reason, it’s been very, very quiet out here. The silence must and will change. I sense you agree.

    Even before I learned about your personal and commendable efforts to stop Delta Dental of Massachusetts from limiting dentists’ fees on procedures Delta doesn’t even cover, I intuitively knew your heart is in the right place by the way you write – even if you don’t quite go far enough to be effective. Nevertheless, the sincerity of your concern for others’ welfare is clear. Thanks.

    Now that we’ve mutually affirmed our dedication to our patients’ best interests, this would be a good time to discuss what we are forbidden to discuss so we’ll know what topics to avoid. I can see how this could get tricky: “YES dentists have been prosecuted for ‘exchanging ( ) ideas’ (you fill in the blank).” Forgive my bluntness, but “you fill in the blank” doesn’t help much if as you say, “price-fixing” doesn’t fit.

    I don’t question your knowledge of anti-trust laws, nor do I intend to ask you to risk an anti-trust lawsuit for you or the ADA. But how are dentists to know which topics are federally forbidden if they are never mentioned? Do you see my point? Dentists simply need more instruction, not surprise audits.

    “Yes, I am on your side I applaud your bringing this topic to the national stage and we all need to advocate for our profession, but we need to do it safely to be effective.” What if years from now “safe” sadly proves to be ineffective at protecting our dental patients from harm? I know your intentions are noble, but if dentists are unsure what’s safe to discuss on the internet and what is not, they won’t discuss anything at all, and our patients will pay the costs. Not us. That’s always been wasteful and wrong.

    I don’t mean to put you on the spot with a rhetorical question, but with the tenets of the Hippocratic Oath in mind, can you think of one reason silence from ADA officials benefits my patients more than open discussion?

    You and I are fighting the same hidden unfairness in the dental industry, but in different ways. Your conventional method depends on the consensus of thousands of fearful, stone-silent dues-paying members. While mine is a consensus of one, and without anti-trust liability … But just to be safe, as far as anyone knows, I never, ever encourage other dentists to express unpopular opinions that nobody wants to discuss.

    Let’s keep it safe.

    D. Kellus Pruitt DDS

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  13. This topic is now closed.
    Editors

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