02/11/2013

CDA responds to Delta Premier fee reduction

CDA offers resources and answers to member questions in a letter from CDA President Lindsey Robinson, DDS:

Dear Colleague,

Delta Dental's apparent intention to reduce provider reimbursement rates within its Premier Plan has prompted concerns and questions from members. We absolutely share your frustration with this impending action, and we are doing everything we can to determine what Delta's actions will be and help members understand the implications for their practices.

CDA immediately conveyed our concerns about this impending action to the highest levels at Delta. We also expressed our strong expectation that Delta comply fully with the law, including the requirements of AB 2252, CDA-sponsored legislation enacted this year, which requires dental plan providers to be given a 45-day notice of any material changes to the plan's contracts and policies.

As of today, we understand from Delta that any changes to Premier fees will not be implemented until the latter part of 2013 and that reductions, expected to be 8 to 12 percent, will be based upon an assessment of each provider's current fee filings, not an across-the-board cut.

It is important to understand that because these contracts are individual agreements between the dentist and Delta, and are written carefully to allow for such fee adjustments, any legal challenge by CDA to their general practice is not likely to be considered by a court. Additionally, antitrust laws require CDA to be careful in responding to or encouraging members on how to respond to actions of third-party payers. However, CDA will monitor the implementation process carefully, leaving no stone unturned on possible legal or legislative responses.

CDA recommends that dentists periodically analyze their various plans and the percentage of patients in each of those plans. CDA Compass has, for several years, constantly updated resources on our website to assist dentists in evaluating their current participating provider agreements with dental plans as well as questions to consider when contracting with new plans. Choosing a Dental Practice Model and the Dental Benefit Plan Handbook, Verification and Explanation of Dental Benefit Coverage can be accessed through your member login.

CDA will continue to seek answers from Delta as to why it is taking this action, but our research through the Dental Benefits Research Task Force has shown that the marketplace for health care in general, and dentistry specifically, is changing rapidly due to the combined impact of the economic recession and the onset of federal health care reform. Employers are influencing the dental plan marketplace, looking for cost-cutting measures to a degree never before seen, and the implementation of the Affordable Care Act is reshaping the medical and dental benefits markets in ways that are extremely challenging for anyone to predict with certainty. The November 2012 CDA Update reported on Delta Dental's presentation to the task force, in which its representatives described the impact these changes were having on Delta's business model.

CDA understands how important this issue is to you. As Delta Dental considers the implementation of this fee reduction, CDA will continue to advocate its members' concerns to the company. We will provide members with information as soon as we learn it and share the resources we have already developed to help our members analyze and adapt to potential changes. Should you have any questions about your contract, please contact CDA Insurance Analyst Ann Milar at 916-554-4994 or our hotline at 916-554-5858.

Sincerely,

Lindsay Robinson, DDS

Lindsey Robinson, DDS
CDA President





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