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Carol Carbone from Lilly Denture Center and WDA Lobbyist Carolyn Logue have been actively engaged in the William H Ruckelshaus Center Mediation process that was authorized in SSB 5351 this past session. If you recall from discussions of that bill, it is a process that stemmed from the Washington State Dental Association’s (WSDA) frustration over Delta Dentals networks, fees, and processes (sound familiar). Because Denturists were having the same problems with Delta Dental (and other insurers), we were able to get denturists into the bill as well. The Legislature determined that this was an issue that needed further discussion and some real mediation so they engaged the William H Ruckelshaus Center at WSU which is specifically designed to mediate difficult policy areas.
The groups engaged in the process include not only WSDA and Denturists, but also Delta Dental, Blue Cross, the Association of Washington Health Plans, consumer and patient groups, and other dental groups such as maxiofacial surgeons. Recently added were “purchasers” from the large and small business communities. The Office of the Insurance Commissioner is actively engaged as well. The goal of the group, according to the legislation, is to: 1) facilitate discussions and address issues related to a dental loss ratio; 2) relative payment for dentists and denturists based upon their provider network status including, but not limited to, payment based on the usual and customary rate; and 3) develop recommendations for legislative or regulatory action. Reports will be provided to the Legislature on a regular basis and a final report is due June 30, 2026. We will make sure WDA members can see those reports too.
Two meetings have been held so far. The first mostly dealt with introductions, making sure the right people were at the table and developing a strong set of ground rules to ensure all parties can engage in real, proactive discussions on issues that can get fairly confrontational. Discussions were started on whether or not there should be a dental loss ratio. Currently medical health plans have a loss ratio (how costs compare to premiums) but dental does not. Washington law just recently started requiring cost and premium data from dental plans. The second meeting, held on November 21st, finalized the ground rules, went deeper into the discussion about whether or not a dental loss ratio would be a benefit to the system (for providers and consumers as well as insurers) and included current data from plans based on premiums and spending last year. In the second meeting the mediators also asked each group to provide a 10 minute presentation on their issues and perspectives related to the system. Carol Carbone did an excellent job describing how the insurance system works for denturists currently and the frustrations/difficulties experienced. Delta Dental also presented and provided a nod to the need to work with Denturists and figure out how to ensure they are able to engage more efficiently.
We expect to get to more meaty discussions in the next two or three meetings — as well as in subsequent work groups that will be formed on specific issues that arise. The group is operating totally on consensus meaning everyone will have to agree on recommendations that go forward in the report. We may not solve all the problems but at least there is now the opportunity to really discuss what is going on and see if we can get to solutions in a friendly manner rather than with a fight. All agree this is the closest we’ve ever gotten to having these types of discussions in the dental insurance arena.
Sincerely,
Carolyn Logue
WDA Lobbyist
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