The California Dental Association is voicing concerns about proposed reimbursement reductions for Premier provider contracts with Delta Dental of California.
The proposed reductions to the "maximum allowable fees" are set to take effect July 1 for about 2,200 specialists in California.
CDA has heard from some concerned endodontists, periodontists and oral surgeons facing reimbursement reductions under their Premier provider contracts. In February, CDA sent a survey to specialist members regarding the proposed reductions, which range from 13 percent to 25 percent or more. Of the more than 500 responses, 42 percent said they will likely have to terminate their contracts with Delta. Another 39 percent of respondents said they hadn't made any decision yet regarding their relationship with the dental plan.
In its notice to members, Delta cited the need to align its contracted fees for these specialties with those generally accepted as network reimbursement levels in the broader market.
CDA has expressed to Delta that the proposed reductions may be based on invalid data and analysis and could potentially violate the duty of good faith and fair dealing.
As part of a 2018 class-action settlement agreement with CDA, Delta must provide Premier providers with 120 days' notice and an individualized illustration of how reductions will potentially affect each dentist's practice based on the dentist's prior 12 months' claim submissions. Delta previously sent such notifications before the pandemic using 2019 data. An issue exists as to whether those notifications are sufficient because they are based on data now more than a year old, according to the CDA.
Becker's did not receive a response from Delta Dental when reaching out for comment. This story will be updated as more information becomes available.