Contracts

Every quarter, CDA publishes a Practice Health Check focusing on a different topic related to the business side of dentistry. Dental plan benefits are the focus in the fourth quarter of 2023. CDA members are invited to take the Q4 Practice Health Check evaluating one key question.

CDA’s experts answer members’ questions about adding a new dentist or utilizing locum tenens and the accompanying considerations for the dentist’s working relationship with dental benefit plans. 

In a live virtual meeting on May 10, members learned about CDA’s litigation against Delta Dental of California and key legislation to improve dental plan transparency and coverage. The presenters also highlighted tools and resources available to CDA members to help ease dental plan frustrations and challenges. 

The Department of Managed Health Care asked Delta Dental to report any rate changes affecting over 10% of its provider network to the department. Additionally, DMHC is monitoring its help desk for calls from consumers.  

Reports from CDA members during the last week on contract change notification letters sent by Delta Dental of California raise additional concerns for CDA about the proposed changes. 

Delta Dental of California is revising its Delta Dental of California Participating Provider Agreement effective June 1, 2022. Although described as an “enhancement,” the contract amendment alters reimbursement for Premier or PPO contracted dentists who treat DeltaCare® enrollees as out-of-network providers. 

Do you have a question about a dental benefit issue? You can receive timely assistance from a CDA Practice Support expert. Simply submit your question online using the dental submission form available within your cda.org account. 

Every July, CDA Practice Support starts hearing from members who have received notice from a dental benefit plan about a forthcoming audit. CDA's dental benefits analyst explains the post-pay audit, when dentists must participate in the audit and dentists' right to appeal the findings.

CDA Practice Support continues to hear from member dentists impacted by Delta Dental of California’s contractual change under Participating Dentist Rule 2, Basis of Fees that took effect September 15, 2018. Dental practices can take action annually to avoid negative impacts.

CDA Practice Support answers a member's question about whether a noncontracted dental benefits plan has a legal right to the contracted fee discount of another plan that the dentist does have a contract with. 

With baby boomers exiting the workforce and losing their employer-sponsored dental coverage, consumers are enrolling in Medicare, the federally administered health care program for all seniors age 65 and older. Practice Support has seen an uptick in member calls related to Medicare Advantage dental plans due, in part, to the aging patient population in their practices and increased Medicare enrollment.

Adding or dropping a contract with a dental benefit plan is a personal business decision. There is no “one size fits all” in these types of business decisions, as what might work for one dentist might not work for another. You may be asking yourself how a dentist can make a good decision about adding or dropping a dental plan/network participation, but there is one key element in each success story.