CDA answers, resources on Delta Premier fee cut

CDA is providing members with the latest information and resources after learning that Delta Dental intends to reduce provider reimbursement rates in its Premier Plan later this year. In addition, CDA is urging Delta to be transparent, timely and forthcoming in its communications with providers about the impending fee cuts and when they will likely be implemented.

“We know members are frustrated and have questions about Delta’s actions,” said CDA President Lindsey Robinson, DDS. “We have expressed our concerns to Delta, at the highest level, and are doing everything we can to determine what Delta’s actions will be, verify the legality of those actions, and more importantly, help members understand the implications for their practices.”

Robinson stated that CDA-sponsored legislation, AB 2252, enacted last year, requires dental plan providers to be given a 45-day notice of any material changes to the plan’s provider contracts and policies.

“That will allow members more time to assess their current participating provider agreements and analyze the impact on their practices,” Robinson said.

CDA has learned from Delta only that any changes to Premier fees will not be implemented until the latter part of 2013 and that the reductions, which are expected to be an average of 8 to 12 percent, will be based upon an assessment of each provider’s region and current fee filings, not an across-the-board cut.

Delta’s contracts, which are carefully written to allow for fee adjustments, are individual agreements between the dentist and Delta. Any general legal challenge to adjustments is not likely to be considered by a court. Due to anti-trust laws, CDA must be careful in responding to or encouraging members on how to respond to actions of third-party payers.

Although Delta has not issued dentists with any information about the fee cuts (at Update press time), research by the CDA Dental Benefits Research Task Force has shown that the marketplace for health care in general, and dentistry specifically, is changing rapidly due to the combined impact of the economic recession and the onset of federal health care reform. Dental plan customers (employers) are looking for cost-cutting measures, and the implementation of the Affordable Care Act is reshaping the medical and dental benefits marketplace in ways never before seen. The November 2012 CDA Update, which can be accessed at cda.org, reported on Delta Dental’s presentation to the task force, in which its representatives described the impact these changes were having on Delta’s business model.

CDA has always recommended that dentists periodically analyze their various plans and the percentage of patients in each of those plans. To assist dentists in evaluating their current participating provider agreements with dental plans, CDA has resources in addition to questions to consider when contracting with new plans. Choosing a Dental Practice Model and the Dental Benefit Plan Handbook, Verification and Explanation of Dental Benefit Coverage can be accessed through a member login.

CDA will continue to advocate members’ concerns to Delta and will seek answers as to why and how the company plans to reduce Premier plan provider reimbursement rates. CDA will provide members with information as soon as possible and encourages members to look for eUpdates and check here for the latest information, a frequently-asked-questions document and resources.

Members with questions about their contracts can contact CDA Insurance Analyst Ann Milar by email or 916.554.4994, or call our hotline at 916.554.5858.

Updated: 10/16/15

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