CDA has heard from many concerned specialist members — endodontists, periodontists and oral surgeons – who are facing reimbursement reductions under their Premier provider contracts with Delta Dental of California. Proposed reductions to the “maximum allowable fees” for approximately 2,200 specialists in California are currently scheduled to take effect July 1, 2021, according to notices previously sent by Delta Dental, which delayed the action from last year due to the uncertainty caused by the COVID-19 pandemic.
CDA has voiced its concerns to Delta Dental that the proposed reductions may be based on invalid data and analysis and could potentially violate the duty of good faith and fair dealing owed by Delta Dental under its contracts with specialists. In its notice to members, Delta Dental cited generally what it referred to as the need to align its contracted fees for these specialties with those generally accepted as network reimbursement levels in the broader market. CDA’s goal is to ensure that Delta Dental is honoring its contractual obligations to members and providers. To achieve that goal, CDA will endeavor to obtain and analyze the actual data that is being used to support the maximum allowable reductions.
In February, CDA sent a survey to specialist members to better understand their reaction to Delta Dental’s proposed reductions to maximum allowable fees, which range from 13% to 25% or more. Among the more than 500 responses, 42% indicated that they will likely find it necessary to terminate their contracts with Delta Dental. Another 39% of the specialists surveyed said they had not yet made any decisions on how the proposed fee reductions would affect their relationship with the dental plan. The survey results raise significant questions concerning the potential availability of services to plan participants under Delta Dental’s current dental plans.
As part of its 2018 class-action settlement agreement with CDA, Delta Dental must provide Premier providers with 120 days’ notice and an individualized illustration of how these reductions potentially affect each dentist’s practice based on the dentist’s prior 12 months’ claim submissions. Delta Dental previously sent such notifications in February 2020, prior to the pandemic, using 2019 data. An issue exists as to whether those notifications are sufficient under the contract because they are based on data now more than a year old.
CDA will continue to keep members informed about the status of our communications with Delta Dental on this issue. Dentists with questions about the fee reduction or impact on their practices should contact Delta Dental at 888.742.4099 or email@example.com.
Additionally, CDA Practice Support has developed an FAQ with a checklist to assist members with understanding the effects of this potential change to their practices. Members may reach the CDA Contact Center at 800.232.7645 and request to speak with a Practice Support analyst.