CDA received a ruling on April 10 from the arbitrators hearing the case against Delta Dental, who decided that CDA cannot participate as a claimant in the arbitration because CDA itself is not a party to the Premier provider agreement that contains the arbitration clause. However, CDA can still offer legal representation to all dentists who are parties to the binding arbitration and will continue to work with and support them throughout the proceedings.
Delta’s effort to prevent CDA from participating directly in the arbitration is surprising because CDA had been willing to present the entire issue to a single binding arbitration, which would have been a simpler and more efficient process. However, Delta’s position gives CDA the opportunity to proceed with a civil action; and as a result, CDA has filed a lawsuit in San Francisco County Superior Court challenging Delta’s actions on behalf of all members with Delta Premier contracts (other than those in arbitration) to prevent Delta from implementing its proposed amendments.
CDA’s legal action stems from Delta’s August 2013 notice to providers that it intended to delete key provisions of participating dentist agreements, including the deletion of a key promise that Delta made to participating dentists in 2010 that, once set, the maximum fee for dental services would not be reduced unless a reduction were justified by filed fees and other specific criteria. CDA contends that the deletion of this key provision is a first step in Delta’s unilateral reduction of the maximum fee levels by an average of 8 to 12 percent. In addition, CDA claims that Delta is failing to determine the newly reduced fees by the contractually required “actuarial calculation” in the Provider Agreements. CDA also contends that patients with Premier policies will be directly harmed by significantly reduced benefits if any unilaterally reduced fee drives Premier dentists out of the Premier network.
CDA will continue to keep members informed on the progress of this legal action in the Update, newsletter and on cda.org.