Latest Ruling in Case of the California Dental Association versus Delta Dental

01/28/2016

A letter from CDA President Ken Wallis, DDS

Dear Colleague,

I am writing to share positive news about CDA’s legal action against Delta Dental. A superior court judge has issued a preliminary ruling in favor of CDA regarding our association’s standing to represent members in the case. The ruling, which allows CDA to pursue legal action on behalf of members, is an important victory because we know that it would be very difficult, if not impossible, for individual dentists to take legal action by themselves against a corporate entity like Delta Dental.

During a hearing last November in San Francisco Superior Court, CDA successfully argued that we had standing as an association — which Delta challenged — to represent members who are Delta Premier providers. The claims CDA is asserting on behalf of members involve Delta’s attempt to reduce and limit Premier dentist reimbursement rates and amend Participating Provider Agreements in order to cut reimbursement rates by 8 to 12 percent and to impose other limitations. CDA claims that Delta’s actions breach the company’s obligations under the Participating Provider Agreements with Premier dentists. CDA and several individual dentists filed suit in 2013 after learning of the proposed cuts. The judge’s ruling is considered a “proposed decision,” which means CDA and Delta may submit written comments if either side believes there are additional issues the judge should consider before issuing a final ruling.

While there are many steps remaining in the litigation, CDA has successfully held off reimbursement cuts to Delta Premier providers for nearly two-and-a-half years and plans to fight for members with the goal of ensuring Delta’s provider contracting and communications reflect the importance of fair business practices that impact providers and their patients. CDA contends Delta Dental must honor its contractual promises on setting and payment of fees, be transparent in its processes, base actions or changes in its provider contracts on valid data as required by the contract, and give fair, accurate and reasonable notice of any changes it seeks to make.

The ultimate outcome of this legal action is yet to be determined, but as your association president, I want you to know that CDA understands the importance of this issue and will continue to work hard to protect your practice and the patients you serve.

CDA will keep you informed about the progress of the Delta legal action in the CDA Update, e-newsletter and on cda.org. In addition, CDA offers many practice management resources and dental benefit guidance through CDA Practice Support at 800.232.7645 or cda.org/practicesupport.

Sincerely,

Kenneth G. Wallis, DDS

President