Update, Jan. 24, 2023: CDA in December met with the California Department of Managed Health Care, which has regulatory oversight of Delta Dental of California, to discuss Delta Dental’s proposed rate reductions for participating Premier and PPO providers, which took effect Jan. 1.
CDA requested the meeting after first sending a letter asking the state regulator to review the soundness of Delta Dental’s proposed reductions given the increasing costs of providing oral health care and the impact of the proposed reductions on Delta Dental’s existing provider network, among other concerns CDA reported below.
As a result of that meeting, DMHC has 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.
CDA has since filed a legal action against Delta Dental challenging Delta’s adjustments to the Premier and PP provider agreements, as CDA reported Jan. 3.
Affected members who have not already done so can log in to read CDA’s FAQ about Delta Dental’s 2023 contractual changes or use a dental plan evaluation checklist to help them understand the potential effects of the contractual changes on their practice.
Dec. 6, 2022: CDA is asking the California Department of Managed Health Care to review the soundness of Delta Dental of California’s proposed rate reductions due to take effect Jan. 1 for participating Premier and PPO providers.
Delta Dental sent notices to participating providers on Sept. 1 announcing several significant contractual amendments and reimbursement changes, including 20-40% rate reductions for most periodontists, endodontists and oral surgeons, as CDA detailed in an email and other communications to members.
CDA has sought clarification from Delta Dental on the methodologies used to justify these changes; however, Delta has stated it will not provide any additional information, claiming the information is confidential and proprietary.
CDA asks state regulator to review ‘the soundness of the proposed reductions’
Now, CDA has asked the Department of Managed Health Care, which has regulatory oversight of Delta Dental, to step in on this “urgent pending issue” to protect provider network standards and timely access to care.
“CDA is deeply concerned that a significant provider rate reduction, such as the one being implemented by Delta, will have a deleterious effect on patient access to care because we anticipate it will result in a significant number of providers leaving the Delta Dental network,” CDA states in a letter sent Nov. 14 to Mary Watanabe, DMHC director.
The letter specifically requests that DMHC review:
- The soundness of the proposed reductions given the increasing costs of providing oral health care.
- The impact of the proposed reductions on Delta Dental’s existing provider network.
- Whether the financial condition of Delta Dental requires such dramatic rate reductions.
- The ability of Delta Dental to meet California’s time and distance standards if the rate reductions take effect.
- The effect of the rate reductions and new administrative rules on patients’ coverage and benefits.
The new administrative rules slated to begin Jan. 1 and referenced in the letter include processing and payment changes that members have told CDA “will detract from patient care and reduce the value of the patient’s benefit plan.”
With the Jan. 1 effective date looming, CDA is in dialogue with DMHC about the proposed changes.
Read CDA’s letter to DMHC (first item under Recent Efforts) for complete details of CDA’s expressed concerns and requests.
Support for CDA members now
CDA will continue to advocate on behalf of members by encouraging DMHC to use its oversight authority to conduct an urgent review of the proposed changes. CDA will also continue to evaluate additional legal, legislative and regulatory actions that may be warranted.
While discussions continue, CDA members have available resources. Affected members who have not already done so can read CDA’s FAQ about Delta Dental’s 2023 contractual changes or use a dental plan evaluation checklist to help them understand the potential effects of the contractual changes on their practice. Members can also contact CDA’s expert analysts with any additional questions.
California dentists may also benefit from a customized analysis of their Delta Dental or other dental benefit plan contract through CDA’s dental benefit consulting service. Available at preferred pricing for CDA members, the service pairs the dentist with an expert analyst for a customized one-on-one analysis of the plan contract’s performance in relation to the practice’s patient base, procedure mix and fees.
CDA will keep members informed of developments through the newsroom and weekly newsletter.