Dentists in California prevailed in a lawsuit against Delta Dental. Read on to learn of the many positive outcomes this provides for dentists when it comes to insurance.
Delayed payments, rejected (but legitimate) claims, lowered payments . . . the list of infuriating games that some dental insurance companies play goes on. You may feel that there is little you can do to fight back. There are success stories, like the one where a state insurance commissioner was convinced to cite and fine a third-party payer for intentionally delaying payment. But some battles are too difficult for a sole practice to fight. That’s when we need organized dentistry to step up. That’s what happened last week. Break out your popcorn and read on!The California Dental Association has reached a settlement with Delta Dental of California. The CDA accused Delta Dental of reducing its reimbursements for its Premier providers without proper notification and in violation of its own participating dentist agreement. After more than three years of litigation, Delta Dental yielded. There are several positive outcomes in the settlement, including that Delta must properly notify its providers of any changes to its reimbursements, and it must also give notice of changes to the CDA so that they may be properly reviewed. Oh, and let’s not forget the more than $34 million Delta must pay to Premier providers who have been affected by the improper fee adjustments.
Man, I love a story with a happy ending. But let’s remember that this is just one insurance provider in one state. If you notice that a third-party payer is playing games, then don’t just get annoyed, take action! Bring the matter to the attention of your local dental society. If there is a genuine legal or contractual violation, then this may be a matter for the state society or even the American Dental Association. Together we can stand up to the big bullies.
Cheers,
Chris
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