The California Dental Association (CDA) filed a legal action against Delta Dental of California, challenging adjustments to Premier and PPO provider agreements.
The adjustments include significant fee reductions for many California dentists, increased administrative burdens, and diminished value of benefit plans, according to the complaint.
The group alleges that the board of directors of Delta Dental violated its fiduciary duties by failing to conduct an appropriate analysis of the need for and impact of the contract changes on 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 John Blake, DDS, CDA president, in a statement to member dentists. “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 had sought clarification from Delta Dental on the methodologies used to justify the contractual amendments and reimbursement changes, including 20-40% rate reductions for most periodontists, endodontists, and oral surgeons.
Delta Dental did not provide any additional information, claiming that it is confidential and proprietary, according to the CDA.
“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 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 for Premier providers whose fees were reduced improperly by Delta Dental’s “inflationary adjustment percentage,” resulting in payments for 14,000 dentists.
In that settlement, CDA also secured 120 days’ written notice of material changes to participating dentist agreements to all contracted Delta Dental providers in California and an individualized illustration of how those reductions would potentially affect the dentist’s practice.