Delta Dental of California notified California dentists in its FYI newsletter that dentists should be prepared for a quality assessment review. CDA members are encouraged to review the on-site QA review checklist provided in the April 9 newsletter to ensure compliance.

On behalf of members, CDA has filed a legal action against Delta Dental of California in San Francisco Superior Court. The action challenges Delta Dental’s adjustments to Premier and PPO provider agreements effective Jan. 1, 2023.

CDA has heard from many specialist members — endodontists, periodontists and oral surgeons — who are facing reimbursement reductions under their Premier provider contracts with Delta Dental of California

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. 

Delta Dental of California has announced a delay in implementing fee structure changes for endodontists, periodontists and oral surgeons. Due to uncertainty caused by COVID-19, Delta said it plans to delay the implementation date of Jan. 1, 2021, to July 1, 2021.

CDA filed the legal action that led to this settlement in August 2013 after learning earlier that year of Delta Dental’s plans to reduce reimbursement rates for the Premier Plan by 8 to 12 percent. CDA claimed that Delta Dental’s attempt to amend the Participating Dentist Agreements (PDA) to pave the way for this reduction was a breach of its “duty of good faith and fair dealing.” 

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. 

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.

Dr. Tippett-Whyte discusses the latest developments with Delta Dental's planned fee cuts and provides insight on CDA’s ongoing advocacy efforts to ensure Delta Dental honors its obligation to providers.

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.