On behalf of its members, the California Dental Association has filed a legal action against Delta Dental of California in San Francisco Superior Court.
The legal action challenges Delta Dental’s adjustments to Premier and PPO provider agreements effective Jan.1, 2023, which include significant fee reductions for many providers, increased administrative burdens and diminished value of benefit plans. CDA alleges that the board of directors of Delta Dental, a nonprofit, tax-exempt company, violated its fiduciary duties by, among other things, failing to conduct appropriate analysis of the need for and impact of the contract changes to Delta Dental’s provider networks and patients.
“CDA is committed to supporting our members in their practices and ensuring the patients we serve can access dental care,” said CDA president John Blake, DDS. “As a dental benefit plan company, Delta Dental has a responsibility to be transparent about such significant changes that affect its provider networks and their patients. CDA believes that Delta Dental failed to adequately consider the basis for and impact of these changes and has failed to offer sufficient justification for these actions.”
CDA previously sought clarification from Delta Dental on the methodologies used to justify the significant contractual amendments and reimbursement changes, including 20-40% rate reductions for most periodontists, endodontists and oral surgeons. Delta Dental, however, has stated that it would not provide any additional information, claiming that it is confidential and proprietary.
“Challenges with dental benefit plans are a top concern for CDA members as we are keenly aware that current dental benefit structures are not working for patients or dentists,” said Dr. Blake. “This litigation is a step toward increasing transparency and accountability. Significant work must be done to develop quality, standardized and meaningful dental benefit plan requirements that meet the oral health care needs of Californians.”
In 2018, CDA and Delta Dental of California reached a $65 million settlement agreement on behalf of Premier providers who had their fees reduced improperly by Delta Dental’s “inflationary adjustment percentage,” resulting in payments ranging from $500 to many thousands of dollars for 14,000 dentists. In the settlement, CDA also secured 120 days’ written notice of material changes to participating dentist agreements to all contracted Delta Dental providers and an individualized illustration of how those reductions would potentially affect the dentist’s practice.