The California Dental Association (CDA) has decided to appeal a judge's decision to dismiss a lawsuit filed against Delta Dental of California in which it accused the insurance company of changing reimbursement rates that negatively affected dentists and patients.
In May 2024, a judge in the San Francisco Superior Court dismissed the CDA's case against Delta Dental asserting that the insurer's directors and officers have unrestrained discretion to set and change contract terms without regard to the effects on dental providers and patients. Also, Delta Dental has no fiduciary duties to clinicians who participate within the company's networks, according to the decision.
"We fundamentally disagree and cannot let this case dismissal go unanswered," CDA President Dr. Carliza Marcos, wrote in an update dated June 18 to its membership.
In December 2022, the CDA filed a lawsuit against Delta Dental of California challenging the company's adjustments to premier and preferred provider organization (PPO) agreements that were effective January 1, 2023. The adjustments slashed payment rates by 20% to 40% for periodontists, endodontists, and oral surgeons. In addition, the modifications increased the administrative burden on dental healthcare providers and diminished the value of benefit plans, according to the CDA.
In the suit, the CDA alleged that Delta Dental amended fees and contracts to improve profits and executive compensation without any regard to the effects on dental providers and patients.
In the CDA's update to its membership, it recognized that though litigation is costly and takes time, it believes this fight is worthwhile. Though the CDA cannot instruct clinicians on the type of financial model they should follow, its experts can assist in helping members make informed decisions.
"Your own patient demographics, practice goals, plans' contractual terms and fees for your more frequently billed procedures all play a role," Marcos said. "Many California practices are fed up, and CDA is here to help members better understand contracts and considerations with plan participation."
