Approximately 14,000 dentists are expected to receive payments by the end of October as part of CDA’s settlement agreement with Delta Dental. The agreement, which was approved by the court in May and followed by a 60-day appeal period, provides $65 million to Premier providers who had their fees impacted by Delta Dental’s “inflationary adjustment percentage.” Under the agreement, Delta Dental has 120 days from the end of the appeal period to distribute the payments to eligible providers. Dentists who did not have their fees reduced improperly by the inflationary adjustment percentage will not receive payments.
Among Premier providers receiving awards, individual settlement payments vary from $500 to many thousands of dollars and are based on Delta Dental’s record of requests for fee increases submitted to Delta, any application of the inflationary adjustment percentage to those requested fee increases, and detailed and individualized claims history for services performed between Jan. 1, 2011, and Sept. 14, 2017.
CDA has received inquiries from Premier providers who did not receive settlement allocations or thought their award amounts should be higher. In many of those instances, Delta Dental records show those dentists did not file for fee increases or did not file at regular intervals. CDA Practice Support recommends that providers file a fee proposal every 12 months from their last fee request, as allowed under the terms of their Premier provider agreement. An office should propose their usual fee at the time of submission. This provides Delta Dental with “true” fee data for a region.
In addition to the monetary settlement, Delta Dental must provide:
- 120 days’ written notice of material changes to participating dentist agreements to all contracted providers.
- Each Premier provider affected by any attempt to reduce reimbursement rates with an individualized illustration of how those reductions would potentially affect the dentist’s practice.
- CDA with 12 days’ advance notice of changes to participating dentist agreements to prepare for questions from members.
Although this agreement does not prevent future rate reductions, CDA successfully blocked Delta Dental’s attempt to reduce Premier provider reimbursement rates during the five-year litigation, which saved dentists — even those not receiving settlement payments — more than $600 million in Premier plan fee reductions.
For settlement details, visit DeltaDentalofCaliforniaSettlement.com Members with questions about the terms or meaning of the settlement may contact CDA at 800.232.7645.