Court

DELTA DENTAL FEE REDUCTIONS

Applicable to Oral Surgeons and Periodontists Effective Jan. 1, 2021

 
Image by Chris Brignola

FEE REDUCTIONS FOR DELTA DENTAL ORAL SURGEONS AND PERIODONTISTS

Our attorneys have analyzed Delta Dental's recent notice of the reduction in fees for oral surgeons and periodontists. Unfortunately, we do not see a basis for challenge due to the settlement and release that the CDA entered into with Delta Dental.


The CDA class action started as a challenge to the very same action by Delta Dental -- the unilateral reduction of fees for Premier Dentists. A portion of the 2013 Participating Dentist's Agreement (PDA) provided that no decrease could take place without the dentist's approval. The language was unilaterally changed by Dental Dental and was part of the litigation initiated by the CDA.


Our attorneys’ analysis of the settlement between the CDA and Delta Dental revealed that there was a monetary settlement for the denial of prior fee increase requests by Premier Dentists, which Delta Dental paid. However, there were no prohibitions on future fee reductions by Delta Dental for Premier Dentists. Instead of a 45-day notice period, the settlement provided for a 120-day notice period before implementing any fee reduction or other change to the PDA. This agreement is binding on all Premier Dentists who did not opt out of the settlement, and is very broad.

CDA settlement contained the following provision:

  • sub-section (d): Other than the amendments described above, Delta Dental has the right to determine unilaterally the provisions of the PDA (including the Rules), including without limitation any provisions relating to fee reimbursement; levels or amounts of fee reimbursement; methods, procedures or formulas for determining fee reimbursement; dispute resolution; and Delta Dental’s right to amend the PDA (including the Rules), provided that nothing in the Proposed Amended Settlement is an agreement that Delta Dental may violate any statutory or common law right by future amendment or other conduct.

As the CDA class action settlement and release closes the door to a challenge of the fee reduction, the class action lawsuit filed by the ADA provides dentists the best chance to obtain justice on this issue.