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.
Challenges with dental plans are at the top of the list of concerns member-dentists share with CDA. On May 10, CDA brought together its legal, legislative and benefits experts along with CDA President John Blake, DDS, to host an informational meeting sharing how CDA is working to address member concerns about dental plans. More than 700 members registered to attend.
Legal action update
Alison Sandman, CDA’s chief legal officer, started the meeting with a report on the legal action CDA filed Dec. 30, 2022, against Delta Dental of California.
Sandman explained that CDA successfully sued Delta Dental in the past, achieving a $65 million settlement in 2018 — the result of a lengthy legal battle that CDA initiated in 2013 after learning of Delta Dental’s plans to reduce Premier provider rates by 8% to 12%.
The current litigation is in response to multiple changes Delta Dental made to its Premier and PPO provider contracts. The action challenges Delta Dental’s adjustments to Premier and PPO provider agreements effective Jan. 1, 2023, which included significant fee reductions for many providers, increased administrative burdens and diminished value of benefit plans.
Sandman said that some of the changes most affecting CDA members are modifications to the payment model for Premier providers and significant fee reductions for specialists, including oral surgeons, periodontists and endodontists. In the suit, CDA alleges that the board of directors of Delta Dental violated its fiduciary duties by, among other things, failing to conduct appropriate analysis of the need for and impact of the contract changes to Delta Dental’s provider network and patients. A recent amended complaint has further refined the suit to include individual plaintiffs and to claim unfair business practices.
Sandman noted that while litigation has proven an effective means of enacting change in the past, it is rarely a quick solution. Delta Dental’s response to CDA’s amended complaint is due in early June, and case updates and additional information will be shared online through CDA’s Dental Plan Action Center.
Legislative advocacy overview
Legislative advocacy efforts were presented by Brianna Pittman-Spencer, CDA’s senior director of government affairs. She explained the reality of what legislation can accomplish and that the key to successful advocacy is focusing on a “greater good” that benefits patients and consumers. CDA’s effort to enact legislative change is a multi-phase effort in pursuit of comprehensive reform, with the goal of ensuring dental benefit plans provide meaningful benefit to patients while being functional and sustainable for dentists.
There are currently two CDA-sponsored bills that address egregious loopholes in dental plan standards and regulations. Both were developed based on the calls and input CDA receives from members about dental plan actions that interfere with patient care and create patient pain points:
- AB 1048. Passing this bill into law would ban waiting periods in large group products, prohibit plans from denying claims due to preexisting conditions and would add premium rate reviews, giving the state authority to review and deem unreasonable dental benefit premium rates.
- AB 952. This bill would require dental plans to disclose to dentist and patients if they are subject to State or Federal law when disclosing member eligibility. Nearly half of all dental plans are exempt from state law, which is why dentists continue to see dental plans behaving in ways that are contrary to their expectations and state law. Having this notification upfront will help dentists explain to patients what their plan will and will not cover, limiting the negative impact of surprise denials.
Pittman-Spencer noted that ongoing member support of legislation is key to its success. CDA member-dentists can join the effort to hold dental benefit plans accountable and require them to provide more meaningful coverage by contacting their legislators and sharing their experiences with plan challenges. Find tools to easily contact your legislator in the Dental Plan Action Center.
Benefit plan resources and consulting
Lisa Greer, a CDA dental benefits analyst, offered an overview of the resources available to help members navigate dental plan challenges and frustrations. She provided a guided tour of many of the member-only tools housed in CDA’s Dental Benefit Plans resource library, including forms and guides to manage bills, claims and appeals. Greer encouraged attendees to refer to information and guidance in CDA’s Dental Benefit Plan Handbook.
In addition, Greer shared two ways members can get assistance from CDA experts for their dental benefit plan concerns: the Dental Benefits Submission Form or CDA’s new Benefit Plan Consulting service for an analysis tailored to their practice.
CDA members can log in to access a recording of the Dental Benefit Plans: Advocacy, Legal Action and Member Support virtual member meeting. Visit cda.org/DentalBenefits to find all of the online tools and resources mentioned during the meeting.