04/16/2015

Ruling in Delta case favorable for CDA


The San Francisco Superior Court judge presiding over the CDA v. Delta Dental case issued her final ruling denying Delta Dental’s motions attempting to have the case dismissed. The final ruling confirmed a tentative ruling of the same nature just weeks prior.

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 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.

In addition to the Superior Court case, a separate arbitration proceeding has been placed on hold after CDA and Delta agreed to litigate the Superior Court case first to avoid duplication of effort and expense. A previous ruling by arbitrators determined that CDA could not be a party to the arbitration because it was not a signatory to participating dentist agreements containing the arbitration clause. However, the arbitrators 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 supports members with sophisticated practice management and dental benefit guidance through CDA 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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