Dental Health Services fined $300,000, ordered to develop plan to fix violations

Citing numerous violations, Insurance Commissioner Mike Kreidler has fined Dental Health Services $300,000 and ordered it to develop a compliance plan to resolve consumer concerns.

Company officials agreed to the order, which requires Dental Health Services to hire an external auditor by Sept. 25.

Kreidler suspended $200,000 of the fine if these conditions are met:

  • The auditor develops an acceptable plan to correct violations.
  • The company meets all requirements of a compliance plan.
  • The company makes whole all enrollees who experienced a delay in care or out-of-network charges because a provider was not available in their service area.
  • No additional violations occur for two years.

Dental Health Services is the second-largest insurer of dental services in the state. It has more than 52,000 enrollees, including over 14,000 signed up through the Washington Health Benefit Exchange. It’s the largest dental insurer in the Exchange.

Key among the violations in the consent order:

  • Failure to timely resolve consumer grievances. Enrollees with issues sometimes waited hours after calling with complaints. The company had no process for managing and documenting issues, including appeals from enrollees.
  • Failure to deliver enrollment and membership materials to enrollees. Many enrollees experienced more than a 45-day wait to get insurance coverage documents that would allow them to see a dentist.

In addition to the fine and order for a compliance plan, Kreidler also is requiring Dental Health Services to fix its provider contracts with dentists by Oct. 30. Kreidler’s office recently investigated complaints about the contracts and found many inadequacies affecting consumer access.

Consumers who have questions about their dental insurance or other type of insurance can contact the Insurance Commissioner’s Office online or by phone at 800-562-6900.

For more information for boomer consumers, see my blog The Survive and Thrive Boomer Guide.

 

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