California Dental Association versus Delta Dental Insurance
CDA is scheduled to present further evidence in its legal case against Delta Dental at a hearing scheduled Nov. 16 in San Francisco Superior Court. This is a further hearing on CDA’s “standing” as an association to represent its members in challenging Delta’s actions relating to reduced fee reimbursements to Premier dentists under the Delta Participating Dentist Agreement (“PDA”).
While arguments on CDA’s legal standing to represent members in the case were presented earlier this year, the judge had remaining questions and allowed both parties to gather evidence to present at the upcoming hearing.
The superior court judge had previously sided with CDA to deny motions by Delta to have the case dismissed.
CDA and several individual dentists filed legal action against Delta in 2013 after CDA informally learned of a planned reimbursement reduction of 8 to 12 percent for Delta Premier Providers. Although the case began as arbitration, it is now in San Francisco Superior Court for reasons described in prior CDA Updates and on cda.org. The case centers on whether Delta Dental has met its contractual commitments under the PDA, which are the same for every Premier dentist. CDA contends Delta Dental must honor its contractual promises on fee reimbursements. CDA also contends that Delta must determine fee reimbursements as required by the contract, be transparent in its processes, base actions or changes it seeks to make in its contracts with providers on valid data as required by the contract, 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 to reduce the reimbursement rates because competing insurers with pure PPO plans are taking business.
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.
As of 11/23/2015 no news updates on this issue.