CDA provides answers about Delta Dental legal action

CDA’s legal action against Delta Dental of California, filed on Aug. 14, has prompted member questions about the next steps in the process. CDA is awaiting an official response from Delta regarding CDA’s filing of a demand for binding arbitration; however, Delta’s attorney contacted CDA’s attorney last week to discuss the case. The filing by CDA on behalf of its members, along with several individual dentist providers, is in response to Delta’s notice dated Aug. 1, informing providers of changes to key provisions in their agreements.

In order to help members understand the legal action, CDA has prepared the FAQ document below. CDA will continue to provide regular updates on developments in the case, but, as is inherent in the legal process, there may be periods of time without significant legal activity. Developments in the case will be reported through the Update, e-newsletters and cda.org

Why is CDA taking legal action against Delta Dental of California?

CDA and several individual dentists are pursuing binding arbitration to require Delta Dental to honor its contractual obligations outlined in the Participating Dentist Agreement between Delta and its participating providers. CDA believes that Delta Dental of California has violated its good faith agreement with member dentists by unilaterally implementing changes to the Delta Dental Participating Dentist Rules, Bylaws and Membership Action Policies and Procedures (MAPP), specifically two key elements: 

  • The revised definition of “Contracted Fees” eliminates language stating that Delta will only lower its maximum amount payable if “participating dentists’ filed or submitted fees decrease to such an extent that Delta is warranted in reducing the maximum amount allowed.” This could allow Delta to implement fee reductions without justification.
  • Revisions to the arbitration process will limit providers’ ability to use arbitration only for disputes arising from claims payment, overpayments and requests for refunds. Currently, providers can use arbitration to resolve a broader range of disputes, such as those related to claims payment, fee fillings, quality assurance and contracting issues.

How does CDA’s legal action impact me?

If you are a Delta Dental provider, the litigation may result in maintaining your current contract terms. If successful, CDA’s legal action will result in Delta Dental’s rescission of the proposed revisions to the Participating Dentist Rules and MAPP.  

If you are not a Delta Dental provider, you may still benefit from CDA’s action since other dental benefit plans will take note of CDA’s action on behalf of its members and the plan(s) may reconsider potential actions in the future that could be detrimental to CDA member dentists.

What action do I need to take as a CDA member?

If you are a Delta Dental provider and are interested in joining the arbitration as a potential claimant or witness, or believe you may have pertinent evidence related to this issue, please contact Jan Katerkamp at CDA at 916.554.4913 or jan.katerkamp@cda.org. Otherwise, no other action is required at this time.

How long will the legal process take? 

While the process is unpredictable, it is likely to take a year or more. There are many factors that could impact the duration of the process, including Delta’s response to the demand for arbitration.

Will CDA’s action delay Delta Dental of California’s proposed fee reduction to Premier providers?

It is CDA’s belief that the proposed contract amendments are the first step Delta is taking to implement a fee reduction. While no one can predict the outcome of a legal proceeding, one purpose of the demand for arbitration that CDA has filed is to challenge any improper reduction in fees that Delta seeks to impose on participating dentists. 

The proposed changes to the Delta Dental Participating Dentist Rules, Bylaws and MAPP take effect on Oct. 4. If the legal action is still pending, how do I know whether to accept or reject Delta’s proposed contractual revisions?

CDA and a number of individual dentists will be requesting injunctive relief to stop the proposed revisions from taking immediate effect. However, it is unlikely a ruling will be issued by then. Determining whether to accept or reject Delta’s proposed changes is an individual decision each member dentist must make on their own based on what is best for his/her patients and practice. Regardless of whether we are able to obtain preliminary relief before Oct. 4, 2013, our action will continue to challenge the lawfulness of Delta’s attempted amendments.