CDA challenges Delta Dental
September 02, 2013
By Kelly Soderlund, ADA News staff
The California Dental Association and several individual dentists filed a formal demand for arbitration with Delta Dental of California to challenge Delta's unilateral decision to revise two significant provisions to its provider agreements.
The first revision restricts dentists' ability to use arbitration to challenge Delta's actions, and the second eliminates the current requirement that Delta provide justification for changing its reimbursement fees. CDA officials point out that both are key provisions that have been in participating dentist agreements for many years. The demand for arbitration, which was filed with the American Arbitration Association, is the step required by the provider agreements in order to raise this type of issue.
“It's to the great benefit of our members to fight these changes,” CDA President Lindsey Robinson said. “We're initiating legal action to require Delta Dental of California to honor their contractual obligations to their provider network, which is composed primarily of CDA members.”
CDA leaders fear the amendment to the justification clause will allow Delta to reduce their reimbursement fees by the end of the year.
“Delta's move to modify the contracts it has with providers appears to fly in the face of good faith and fair dealing,” said CDA Vice President Walt Weber, chair of the CDA Dental Benefits Research Task Force. “CDA absolutely questions whether, once Delta provides the information required by the contracts, fee reductions would be justified.”
Dr. Robinson expects more dentists to join the demand for arbitration. The earliest these changes would take effect would be Oct. 4
“We hope the end result will be sending Delta a strong message that they need to improve their relationship overall with their dentist members,” Dr. Robinson said. “They need to improve their relationship with the California Dental Association. They need to be more transparent with the policy decisions they make moving forward. We hope this litigation results in the current contract terms being maintained.”
The ADA offered its support to CDA's challenge.
“We certainly support CDA's efforts on behalf of its members to challenge the insurer's unilateral revisions of its provider contracts,” ADA President Robert Faiella said. “We will monitor this situation closely to see if there is any way to lend our assistance”
In a recently released statement, Delta Dental of California said the challenged revisions had been approved in advance by California regulators and communicated to its 23,172 participating dentists. With regard to the action by CDA, Delta said:
“While we cannot comment on the specific issues mentioned in the complaint filed, we are disappointed that the CDA is pursuing this course of action. Delta Dental's intent is to provide the best and most affordable dental benefit programs possible for its 15,000 California business and government customers, which serve 18 million people in California. Delta Dental is committed to acting in the long-term best interests that balance the needs of all its stakeholders, including enrollees, client groups and dentists, and the changes we proposed are necessary to ensure that we can continue to deliver quality dental programs at an affordable price.”