As your association president, I share and understand your frustration and anxiety regarding Delta’s intentions to reduce its Premier plan provider reimbursement rates. The significant reductions of an estimated 8 to 12 percent expected later this year, we think, will be based upon an assessment of each provider’s region and current fee filings, not an across-the-board cut.
I want to assure you that CDA is seeking definitive answers from Delta. We firmly believe in transparency and are urging Delta in this letter to immediately communicate its impending actions and reasons to Premier plan providers. Delta’s unwillingness to communicate with providers on something that will have significant impact on individual contracts and potentially narrow the network is unacceptable.
Members have contacted CDA asking for support in managing this change, and we are here to help you understand your options. We will also monitor Delta’s implementation of these changes and evaluate whether any legal or legislative actions are needed to address the issue.
While Delta Dental has not been forthcoming with its reason for cutting reimbursement rates, it has indicated previously that cuts in other states were necessary to remain competitive and viable. In fact, Deltas have established a pattern of reimbursement reductions, with California being the latest target:
- Washington state: 15% reduction (2011)
- Idaho: Up to 13% reduction (2011)
- New Jersey and Connecticut: Up to 5% reduction (2012)
Such fee reductions are not a violation of state laws or regulations. Your contract with Delta is carefully written to allow for fee adjustments, and because it is an individual agreement between you and Delta, it is unlikely that any legal challenge by CDA would be considered by the courts. In addition, anti-trust laws that prohibit CDA from responding to or encouraging actions attempting to change or set fees also apply to individual dentists.
However, we are doing everything we can to protect and assist members in this rapidly changing health care marketplace. CDA has many practice support resources on the CDA Compass that can help you evaluate existing provider agreements and new provider contracts. CDA also sponsored a new law that requires insurance companies to give dental plan providers a 45-day notice of any material changes to contracts and policies.
We are strongly advocating your concerns to Delta in this accompanying letter and intend to verify the legality of its actions with the Department of Managed Health Care and others during this process. We encourage you to reach out to us for support by contacting CDA Insurance Analyst Ann Milar at email@example.com or 916.554.4994, or call our hotline at 916.554.5858. There will be more information provided in the Update and on cda.org.
Lindsey Robinson, DDS