CDA is making every effort to provide members with the latest information concerning Delta Dental’s apparent intention to reduce provider reimbursement rates for its Premier Plan.
A legal action was filed in August 2013 by CDA and several individual dentists challenging, in part, Delta’s attempt to change Premier provider agreements. Prior to the filing, CDA learned informally of a planned rate reduction of 8 to 12 percent. A recent decision by arbitrators will allow the arbitration to proceed despite a motion by Delta to dismiss it.
In August 2013, CDA and several individual dentists filed a legal action against Delta Dental challenging, in part, its attempt to change Premier provider agreements. In response to this action, Delta filed a motion to dismiss the entire matter. After considering the motion, the arbitrators rejected Delta Dental's recent motion to dismiss the entire action, and found that there was sufficient evidence to allow the individual dentists to proceed on their claims that Delta's attempt to change key provisions of its participating dentist agreements violated the legal doctrine of "good faith and fair dealing." The decision will allow the arbitration to proceed.
CDA learned in late May that Delta Dental of California began distributing a new Participating Provider Agreement (Commercial Fee-for-Service) to newly contracting California providers. For those newly contracting providers, this new agreement appears to be an all-inclusive provider agreement for both the Delta Dental Premier and PPO products. CDA understands that Delta Dental will no longer offer separate Premier and PPO provider agreements to newly contracting dentists. Along with the new Provider Agreement, newly contracting dentists will receive the Delta Dental Premier Addendum.
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.
CDA’s arbitration with Delta took a step forward on Feb. 25 with a “preliminary hearing” conference call with the panel of arbitrators assigned to the case. The purpose of the call was to schedule dates for different stages of the arbitration. In light of the extensive briefing that has already been submitted by both parties, the panel of three arbitrators has indicated it will likely decide two significant issues by early April.
CDA’s legal action against Delta took a step forward with a decision by the American Arbitration Association to select three arbitrators to hear and decide the case. The selection of an arbitration panel meant the case was able to move forward with a preliminary conference scheduled Feb. 25.
CDA’s legal action against Delta remains in the preliminary stages, with the parties awaiting appointment of an arbitrator. Delta has requested appointment of a three-arbitrator panel, which delayed the appointment process while the parties attempted to resolve the issue.
On Oct. 1, Delta Dental of California issued a formal Answer to the Demand for Arbitration. Delta asserts that it has the right to amend Participating Dentist Agreements based on language in the contracts and its notification to the Department of Managed Health Care indicating that it intends to revise the provider agreements.
The lengthy arbitration process between CDA and Delta Dental has commenced, with the parties entering into discussions about the selection of an arbitrator. Delta is expected to file a formal response to the demand for arbitration on or before Oct. 1.
CDA’s legal action challenges both Delta’s right to make certain amendments to dentists’ individual contracts and reduce Premier fees unilaterally. CDA will request that the arbitrator, once appointed, maintain the status quo until a final ruling is made in the binding arbitration.
CDA’s legal action against Delta Dental of California, filed on Aug. 14, has prompted member questions about the next steps in the process. In order to help members understand the legal action, CDA has prepared a FAQ document. CDA will continue to provide regular updates on developments in the case.
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.
While California providers are still waiting to hear from Delta Dental of California about expected fee reductions for its Premier Plan, Missouri dentists received a letter recently from Delta Dental of Missouri that outlined plans in that state to reduce reimbursements to providers who participate in Delta’s Premier and PPO networks. The fee reduction, which went into effect July 1, averages 7 percent. Delta Dental of California has not been forthcoming with its reasons for cutting reimbursement rates, nor has it officially informed California providers about its intentions; however, the reductions are expected to be an average of 8 to 12 percent implemented later this year.
The move to restore adult Denti-Cal benefits is one step closer to reality after the governor and state lawmakers agreed to include funding in a preliminary budget deal. The restoration of benefits, which still needs final budget approval, would begin in May 2014, with a proposed annual cost of $77 million.
CDA continues to advocate on behalf of its’ members concerning Delta Dental’s intention to cut Premier Plan provider reimbursement rates an expected average of 8 to 12 percent later this year. The following letter from CDA President Lindsey Robinson, DDS, explains to members that Delta has a responsibility and an obligation to communicate with its providers when inquiries are made, not limited to the legally required 45-day contract policy notice period, and failure to do so can result in providers filing complaints. The letter is as follows:
Since learning of Delta Dental’s decision to cut fees an expected average of 8 to 12 percent for its Premier product, CDA has pressed Delta for more specific details about the impending fee reduction. We have compiled a list to inform members about what we currently know. CDA will continue to provide information as soon as possible to keep members informed.
In a letter from CDA President Lindsey Robinson, DDS, the association is urging Delta Dental to communicate answers to providers about its impending rate reduction. Dr. Robinson’s message to members and the letter to Delta are posted here.
The March 2013 issue of the CDA Update features ways CDA Presents is valuable for new dentists. Specifically, six courses that new dentists will benefit from are highlighted. Spotlighting the key role that sterilization volunteers play at CDA Cares clinics, Diane E. Morgan-Arns, who served as the lead for sterilization at the CDA Cares Modesto and Sacramento clinics, and Eve Cuny, director of Environmental Health and Safety at the UOP, Arthur A. Dugoni School of Dentistry are interviewed.
CDA is providing members with the latest information and resources after learning that Delta Dental intends to reduce provider reimbursement rates in its Premier Plan later this year.
CDA offers resources and answers to member questions in a letter from CDA President Lindsey Robinson, DDS.
CDA has learned that Delta Dental is planning to reduce reimbursement to its Premier Providers. We are now in contact with Delta to obtain details and clarification about this decision. It is likely these reductions will average 8 to 12 percent and may vary by region and provider. The reason for the reductions is not yet clear, but it is likely to be market pressures and a resultant effort to reduce the cost of the Premier plan for employers in order to keep it viable. The reductions will not go into effect immediately, but are intended to be implemented later this year.
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