03/24/2015

CDA wins tentative ruling in Delta Dental case


The San Francisco Superior Court judge presiding over the CDA v. Delta Dental case issued her tentative ruling at a March 18 hearing denying Delta Dental's motions attempting to have the case dismissed. While her rulings in open court are currently tentative, the judge stated that she would issue a final order soon and it would be consistent with these tentative rulings. This is positive news for CDA and CDA member Premier dentists, however, there is still a long way to go in the litigation.


CDA's complaint is centered on whether Delta Dental has met its contractual commitments regarding fee reimbursements to Premier dentists and whether Delta Dental has provided fair and adequate notice of the changes that it seeks to make in the participating dentist agreement. CDA contends Delta Dental must honor its contractual promises, and must be transparent in its processes, submit comprehensive data to justify any actions or changes it seeks to make in its contracts with providers and give fair, accurate and reasonable notice of any change it seeks to make. Delta Dental counters that "competitive realities" in the marketplace require it to make changes in the agreement and the reimbursement rates because competing insurers with pure PPO plans are taking business.

The judge indicated that she has remaining questions on the subject of CDA's standing to represent its members that she wants the organization to address. The judge may want to hear further evidence on this issue in the next few months and CDA will be prepared to respond. The next scheduled proceeding in the case is a case management conference before the court on April 10 to set a schedule for further proceedings in the case.

The Superior Court case in which the hearing and tentative rulings took place is separate from the arbitration proceeding, currently scheduled for a hearing in June. In the arbitration, the arbitrators ruled that CDA could not be a party because it was not a signatory to participating dentist agreements containing the arbitration clause. However, the arbitrators also found that there was sufficient evidence to allow individual dentists to proceed with claims that Delta Dental's actions have violated the legal doctrine of "good faith and fair dealing" that is implied as a part of the participating dentist agreement. Delta Dental appears to argue that the result of the arbitration proceedings would apply only to the individual participants, which necessitated CDA filing the Superior Court action. CDA is working to coordinate the arbitration and the Superior Court action to avoid duplication of effort and expense.

CDA is here to support members with sophisticated practice management and dental benefit guidance through CDA's Practice Support at 800.232.7645 or cda.org/practicesupport.

CDA will continue to keep members informed about the progress of both legal actions against Delta Dental in the CDA Update and on cda.org.



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