California Dental Association Reaches Settlement with Delta Dental

In a lawsuit filed on behalf of dentists in California, the California Dental Association has reached a favorable settlement against Delta Dental, the largest dental plan system in the U.S. The proposed settlement comes after three and a half years of litigation against Delta, which attempted to reduce reimbursement rates for dentists providing services under the company’s Premier Plan.

The CDA claimed that Delta breached its contractual commitments to dentists by attempting to lower reimbursement rates by 8-12 percent for the Premier Plan. When the lawsuit was filed, the CDA alleged Delta’s attempt to change participating dentist agreements amounted to a breach of contract. Further, the CDA said Delta did not adequately notify participating dentists of its plan to reduce reimbursement rates.

During litigation, the CDA also discovered that Delta was imposing additional limitations on dentists’ annual fee filings for participation in the Premier Plan network. These limitations were not authorized in any PDAs.

In response to the litigation outcome, the American Dental Association has expressed support for the CDA and for dentists in California. Gary Roberts, D.D.S. and ADA President, says, “The ADA is pleased that the California Dental Association has reached a settlement with Delta Dental with terms very favorable to the dentists of California. We support CDA’s efforts on behalf of its members to challenge unilateral revisions of its provider contracts. Ultimately, the settlement benefits the patient, the provider and the profession.”

According to the CDA, the outcome of the lawsuit has saved dental providers in the state almost a half-billion dollars in fee reimbursements. The settlement was reached on behalf of all dentists in California who had a PDA for participation in Delta’s Premier Plan network anytime from January 1, 2011 until December 31, 2016.

Ronald Riggins, D.M.D. and Chair of the ADA Council on Dental Benefit Programs, says, “This effort should remind all dentists who have contracts with any third-party payers to review your contracts. Dentists should request copies of their contract from the payer and explore whether future changes can be provided as redlined changes to the contract.”