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Delta Dental’s notice of upcoming contract changes raises concerns for dentists, CDA

Members encouraged to evaluate impact of contract changes on their practice, share feedback with CDA

September 14, 2022 3293

Quick Summary:

As CDA shared in an email to members last week, Delta Dental of California sent a notice to its participating Premier and PPO providers of upcoming changes to its provider agreements, including fee changes that will be effective Jan. 1, 2023. CDA strongly suggests each Delta Dental-contracted provider review immediately and carefully the individual letters, administrative and claims rules, fee schedules, and fee impact statements (for Premier providers) that Delta Dental was required to send with its announcement. 

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. Here is a summary of actions CDA is taking and the steps that CDA urges members to take now:

  • CDA continues to press Delta Dental for an explanation about rate methodology, new administrative burdens and overall value of Delta Dental benefit plans.
  • Members are encouraged to review Delta Dental contracts to evaluate the impact to their practice and to use the CDA dental benefits issue form to share positive or negative feedback with CDA.
  • CDA continues to evaluate whether any legal or legislative action would be appropriate on behalf of our members based on the announced changes. 

As CDA shared in an email to members last week, Delta Dental of California sent a notice to its participating Premier and PPO providers of upcoming changes to its provider agreements, including fee changes that will be effective Jan. 1, 2023. Based on member reports in the initial days following receipt of the contract change notification letters, it now appears that Delta Dental may have been less than forthcoming about the actual impact of the changes it announced, particularly about adjustments to PPO provider contracts.

Delta announcement of contract changes effective Jan. 1, 2023

As Delta Dental is required to do by our prior litigation settlement, Delta Dental gave CDA short advance notice of these changes. CDA immediately followed up with Delta Dental executives, asking them for information about the actual impact of the changes and the methodology behind them. In those communications, Delta Dental provided little detail and represented that the information is “confidential and proprietary.” However, they did say the impact of the changes on PPO providers in particular would be “positive” and that PPO providers would be especially “pleased.” Delta Dental also advised that decreases to the specialist fee reductions would be less than those it announced in 2020 and then rescinded last year.

We were hopeful these representations by Delta Dental were accurate, as it has been reported — and Delta Dental acknowledged — that PPO fees have not been increased in many years while the cost of providing dental care has increased significantly over those years.

Following Delta Dental’s notification on Sept. 1, CDA relayed what we had learned to our members. We included what Delta Dental had shared about the impact without endorsement of Delta Dental’s actions. The communication also highlighted CDA resources and tools to assist members with evaluating how these changes may impact them, their practices and patients. The communication also emphasized that CDA continues to evaluate whether any legal or legislative action would be appropriate on behalf of our members based on the announced changes. 

Member reports do not match Delta’s representations of fee changes

Based on member reports in the initial days following receipt of the contract change notification letters, it now appears that Delta Dental may have been less than forthcoming about the actual impact of the changes it announced, particularly about adjustments to PPO provider contracts. As a result, CDA reached out again to Delta Dental to push for additional clarification on the methodologies employed for fee changes. Representatives from Delta Dental maintain that general dentists in the PPO network received an aggregate increase and that decreases to the specialist fee reductions were less than those announced in 2020. 

Specifically, we have heard from members that on many of the frequently used codes, contracted PPO providers will experience fee decreases in January or increases that could reasonably be considered rounding errors. Dentists have also reported contracts including more burdensome administrative requirements and restrictions that would detract from patient care and reduce the value of the patient’s benefit plan. These reports from members raise great concern for CDA regarding the true impact of the Delta Dental changes. 

CDA will continue to push Delta Dental executives for additional clarification and facts on members’ behalf. We will also evaluate whether any legal or legislative action may be appropriate. Transparency and accuracy are fundamental to CDA, and we will share significant information that we learn unless constrained by law from doing so.

Take action: Review contract changes

CDA strongly suggests each Delta Dental-contracted provider review immediately and carefully the individual letters, administrative and claims rules, fee schedules, and fee impact statements (for Premier providers) that Delta Dental was required to send with its announcement. 

While Delta Dental will always claim that the methodology behind its changes is “proprietary,” what matters more is the actual impact on each provider. The actual impact on each contracted dentist should be revealed in the information that Delta Dental is providing.

For obvious reasons, each dentist needs to review this information right away to assess how these changes affect your practice and your patients. Delta Dental representatives are requesting that participating providers contact their provider concierge department to discuss the impact of the fees on an individual basis. Please reach out to Delta Dental of California Provider Concierge team at 888.742.4099 or via email to discuss the impact to your practice and raise any questions or concerns you may have with the communication you received about the upcoming 2023 changes.

In addition to contacting Delta Dental, we encourage you to share your feedback, either positive or negative, with CDA on the proposed changes as they apply to your practice by using the dental benefits issue form online or emailing your comments to CDA Practice Support. 

All dentists must make their own independent, individual decision about the course of action most appropriate for their practice in light of Delta Dental’s announcement. CDA offers several valuable resources to help with this analysis: 

  • Members can refer to the specific FAQ regarding the Delta Dental contractual changes, as well as an Evaluating Dental Benefit Plans Checklist that will help enhance members’ understanding of potential effects of these changes to their practices. 
  • For a customized analysis and expertise on your practice’s specific benefit plan contracts, CDA offers an affordable consulting service that analyzes a benefit plan contract in relation to the practice’s patient base, procedure mix and fees.
  • Members who need assistance assessing or using CDA resources can submit a question online, send comments via email or call 800.232.7645 and request to speak with a Practice Support analyst.

We look forward to your feedback and will continue to work with you to do whatever possible to help you succeed in your practice.