DELTA DENTAL: To Launch Grassroots Lobbying Effort
In an unusual foray into lobbying, Delta Dental Plan of California is leading a California Association of Dental Plans effort to "shelter" the dental industry from managed care reforms pending in the state Legislature, the Wall Street Journal/California Edition reports. Traditionally, dental insurers have left the big-time lobbying to the state's HMOs. Central to the dental group's strategy is ready admission, in the words of Delta's Jeff Album, "A good portion of the claims that we deny is for care that we agree is needed and should be provided." But the dental plans argue that such care denials are not harmful in the way that denying coverage for, say, chemotherapy. Album said, "Generally, we're not denying care that people can't afford on their own. We're not denying care that's needed to save lives." If Delta denies a claim, it's because "the contract (with the customer) simply does not authorize us to pay for it. Dental is just different."
Wait a Minute...
Whether that argument will hold water remains to be seen. Warren Barnes, supervising counsel for the state Department of Corporations, said both HMOs and dental plans "are subject to the 'heart and soul' of the state law on health plans: Medical or dental decisions must be 'rendered by qualified medical providers, unhindered by fiscal and administrative management." The CADP is kicking off a $60,000 grassroots lobbying campaign --with the slogan, "dental is different" -- to combat "a list of 11 'hot' bills the insurers either oppose or are watching closely." Primary targets include two measures "that would hold all managed care plans liable for medical malpractice," a bill that would "subject dental plans to external, independent review on disputed claims," and a bill to limit "any health plan's administrative costs at 15%." Sen. Liz Figueroa (D), who is a sponsor of several of the targeted measures, said the plans may have their work cut out for them, especially as the California Dentists Association has long been lobbying for the measures. Figueroa said the dentists have "already gone out and made relationships with their legislators. So (the dental plans) definitely are having to catch up and play defense" (Benson, 5/5).
Dental Bill of Rights
Delta Dental yesterday released it own list of "Patient Rights and Responsibilities" yesterday:
- The right "of patients in fee-for-service dental programs to visit any dentist of their choice, and the right of dental HMO patients to choose a new HMO dentist quickly and easily."
- The right to "easy access to specialty care."
- The right "to clear and complete information about their Delta and PMI benefits," including treatment options and costs.
- The right to review coverage decisions, and to appeal "under a fair and easily-navigated grievance system."
- The right to have coverage decisions made independently of "the bottom line"