On behalf of its members, the California Dental Association — along with several individual dentist providers — has taken legal action against Delta Dental of California by filing a demand for binding arbitration in response to Delta’s notice dated Aug. 1, informing providers of changes to key provisions in their agreements.
Delta is unilaterally attempting to change two significant provisions of providers’ agreements: the first restricts dentists’ ability to use arbitration to challenge Delta’s actions, and the second eliminates the current requirement that Delta provide justification for changing its reimbursement fees. Both are key provisions that have been in participating dentist agreements for many years. Delta has provided no explanation for its attempt to delete them now, although it appears to precede the anticipated action by Delta to reduce fees without justification by the end of this year.
“CDA is committed to supporting our members in their practices and the patients they serve,” said CDA President Lindsey Robinson, DDS. “Delta’s unilateral attempt to change key provisions of its contracts would allow Delta to abandon its responsibility for justifying its payments to contracted providers. This move toward non-transparency appears to be motivated by Delta’s desire for financial gain, not to improve patient coverage or care. It leaves us with no choice but to seek a legal remedy.”
CDA is taking this legal action to ensure that Delta will honor its current contracts with dentists and continue to be required to justify reducing fees in the future.
“Delta’s move to modify the contracts it has with providers appears to fly in the face of good faith and fair dealing,” said CDA Vice President Walt Weber, DDS, chair of the CDA Dental Benefits Research Task Force. “CDA absolutely questions whether, once Delta provides the information required by the contracts, fee reductions would be justified.”
Delta Dental issued a statement concerning CDA’s legal action, stating that its “intent is to provide the best and most affordable dental benefit programs possible” for its business and government customers. It also said, “… the changes we proposed are necessary to ensure that we can continue to deliver quality dental programs at an affordable price.”
Due to the 2012 CDA-sponsored law requiring dental plans to provide 45 business days’ notice of any provider agreement changes, Delta’s recently proposed changes cannot take effect until Oct. 4 at the earliest, allowing time for dentists to review how these changes will affect their practices.
“We have done significant analysis of this issue, and we take very seriously the concerns of our members regarding dental benefit plan issues,” Weber added.
CDA members seeking more information or expressing an interest in participating in the litigation can contact Jan Katerkamp at 916.554.4913 or email@example.com.
More information is also available in these FAQs.