The California Court of Appeal has decided CDA’s appeal of the Superior Court ruling in CDA’s lawsuit against Delta Dental of California. In summary, the Court of Appeal ruled:
- Delta’s current business practices of “unfettered discretion” when it comes to setting reimbursement rates and ability to “unilaterally” change them, as long as notice is provided, do not violate Delta’s contractual obligations to dentists.
- Delta’s directors and officers are not legally required to act in the best interests of dentists who participate in the Delta network.
- The courts do not have the ability to impose restrictions on parties to a contract that contradict the express terms of the contract.
CDA with the support of a top-tier legal team argued to the Superior Court and the Court of Appeal that Delta Dental and its individual directors and officers should not have unrestricted control when setting reimbursement rates. While Delta’s vision statement claims to “take exceptional care of customers, providers and each other,” in reality, Delta fought in court to protect its business practices of increasing profits and boosting executive compensation without being restricted by objective and fair standards.
“The Court may have ruled that there isn’t legal recourse for Delta’s actions related to the 2023 provider contract amendments, but that doesn’t justify Delta’s actions as right or fair,” said CDA President Max Martinez, DDS.
The system of dental plan coverage available today to patients, employers and dentists is broken with stagnant reimbursement rates, dental plans that don’t provide meaningful benefits to patients and contract provisions that negatively impact our practices and our patients. The Court’s decision underscores just how broken the system is.
“This ruling concludes this legal case, but it does not conclude CDA’s resolve in pursuing comprehensive dental plan reform to improve the current conditions that strain dental practices and care delivery,” Dr. Martinez added.
New dentist-led workgroup will focus on comprehensive dental plan reform
Delta Dental, California’s largest dental plan corporation, is choosing a path of unjust business practices, but those practices are the norm in the industry. What’s becoming increasingly clear is that the limited powers of the courts, regulators and the legislature have fallen short of addressing the business behaviors that need to be corrected for comprehensive change.
Because CDA is fully committed to achieving something better for members and their patients, the CDA Board is appointing a new workgroup that will define a new way forward on comprehensive dental plan reform. Composed of dentists from around the state and supported by industry experts, the workgroup will fully focus on what CDA can do, including developing a plan structure and benefits design that more effectively and fairly meets the needs of patients, is sustainable and functional for dentists, and viable for employers/purchasers.
The CDA Board charged the workgroup with:
- Building a better dental plan: What kind of dental plan structure and coverage would be needed to better meet the oral health needs of patients, including minimum standards in benefits or coverage such as setting standards for deductibles, eliminating or standardizing annual maximums, and establishing minimum required benefits.
- Determining how and to what extent dental coverage could be more closely aligned to, or integrated with, medical coverage and systems of care would be positive for dentists and their patients.
- Reviewing existing dental plan models and pilot programs including those within public programs and analyzing premium and out-of-pocket costs to individual enrollees and employer purchasers.
- Discussing coverage structure and cost with brokers, employer purchasers or their representatives to understand the driving forces and interests of these groups as well as what level of understanding and communication is happening with employers/purchasers regarding the value and structure of dental plans.
10 successful dental plan reform bills plus more initiatives underway
In the meantime, CDA-sponsored legislation that gives dentists clear choices and real protection when dealing with virtual credit cards was signed into law this week. And other CDA-led initiatives are underway that would add to the 10 impactful bills signed into law in recent years under the guidance of the CDA Government Affairs Council and with the grassroots support of members from around the state.
CDA’s and the board’s commitment to enacting meaningful solutions to a broken dental plan system is unwavering. California dentists are encouraged to follow ongoing efforts in the Dental Plan Action Center.