Washington state Insurance Commissioner Mike Kreidler has fined Delta Dental of Washington and its healthcare benefit manager $130,000 for improper claim denials, according to a Dec. 12 news release from the commissioner's office.
Here are six things to know:
1. Delta Dental of Washington and Wyssta, its HCBM, were fined for multiple state insurance law violations, including denying claims based on terms that had not been filed and approved with the Office of the Insurance Commissioner.
2. Wyssta took over managing Delta Denta'’s enrollment, invoicing, payment, and claims administration on Jan. 1, 2022, which led to an increase in complaints filed with the OIC.
3. In 2023, the OIC conducted a review of Delta Dental, which found the company had committed violations related to notice and disclosure requirements, policy misrepresentations and claim denials.
4. Delta Dental is also required to post which HCBMs it is contracted with, and the service each HCMB provides, on its website. The company did not release a public notice about contracting with Wyssta for five months.
5. A review of Delta Dental's claims from Jan. 1, 2022 through Dec. 31, 2023, found that 23 claims had limits applied that were not documented in the plan contract.
6. The review also revealed that seven separate service types had denials and processing limits that were not disclosed to consumers in plan documents, which included 50 separate billing codes. Wyssta updated its claim processing system in April 2023 to correct the problems.