What started the legal action that led to this settlement?
CDA filed the legal action in August 2013 after learning that Delta Dental planned to reduce Premier contracted fees by 8 to 12 percent. CDA brought the litigation in order to protect the rights of its members and to require Delta Dental to honor the terms of its contracts.
CDA claimed that Delta Dental’s attempt to amend the Participating Dentist Agreements (PDA) to pave the way for this reduction was not allowed under contract law. CDA also maintained that Delta Dental had not fairly and adequately disclosed its plan to reduce reimbursement rates.
In the course of the litigation, CDA discovered that Delta Dental had been imposing additional limitations on provider annual fee filings for participation in the Premier network that CDA concluded Delta Dental’s PDA did not allow.
Are there any benefits beyond the $65 million payment?
Yes, some 14,000 dentists have been allocated an amount ranging from $500 to many thousands of dollars, with the average calculated at approximately $4,500. However, through the litigation, CDA was able to secure additional protection and information for dentists and their practices.
- Delta Dental must provide 120days’ written notice of significant PDA changes to all contracted providers (instead of the 45 days’ notice currently required by California law).
- Delta Dental must provide each Premier Provider affected by any attempt to reduce reimbursement levels with an individualized analysis of the potential financial impact to his or her practice based on that dentist’s prior 12-month submissions to Delta Dental.
- Delta Dental must also provide 12 days’ notice to CDA of changes to PDAs so that CDA has time to review the changes before they are implemented and can be prepared to respond to member inquiries.
Why won’t all Premier contracted dentists receive money from this settlement?
During litigation, CDA discovered that Delta Dental had been imposing limitations on provider fee filings. As part of the settlement, those Premier dentists who had their fees reduced by Delta Dental’s “inflationary adjustment percentage” are eligible to receive proportionate reimbursements based on the amount their fees were limited. Those not receiving settlement reimbursements were not affected by the inflationary adjustment percentage, meaning they did not have their fees reduced improperly and did not suffer monetary damage.
My practice is not receiving any payment as part of the settlement. How did this legal action help me?
Aside from the additional protections and information listed above, CDA successfully blocked Delta Dental’s attempt to reduce Premier Provider reimbursement rates during the five-year litigation, saving dentists — even those not receiving settlement payments — more than $600 million in Premier plan fee reductions. It’s important to remember reimbursement rates would have been reduced five years ago had CDA not taken action on behalf of members.
Can CDA challenge other Delta Dental contract provisions or policies?
Dental benefit plans generally write their contracts in a manner that allows for amendments and fee adjustments and, typically, such provisions are allowed under the law. In this case, however, CDA saw a unique opportunity to take action and establish that in a proper case a dental association can assert the contract rights of its members and hold a dental benefit plan accountable for actions that appeared to violate California contract law. Specific language in the Premier Provider agreement provided this opportunity.
Will Delta Dental drop my fees?
Delta Dental has not announced an intent to lower its fees. However, it is not a violation of the current provider contract or law to lower fees as long as proper protocols are followed and adequate disclosure is provided. At this time, CDA had not received word of any fee adjustments. Anything else that you may have heard is speculative.
Can I request a fee revision from Delta Dental?
CDA Practice Support advises that the best practice is to file fee proposals whenever allowed by a dental benefit plan. Currently, Delta Dental allows Premier filing of a fee proposal every 12 months.
It is important to file your usual and customary fees as most large dental insurance carriers monitor the fees submitted on dental claims. The carriers evaluate the fees submitted to help establish fees for the participating dentists in a given region or market. If you bill your contracted fee instead of your full fee, you can bring down the “average” fee in your region/market area. Please keep in mind that the proposal is a request not a guarantee of fee increase.