The most notable difference between the final approval and the initial settlement announced in March 2017 is the increase in the amount the insurer will pay, from $34 million to $65 million. In the final settlement, the average allocation that more than 14,000 California dentists will receive from Delta Dental is greater than $4,400.
"We told our members we would go to the mat for them and that's exactly what we did," CDA President Natasha Lee, DDS, stated in a press release.
The dispute centered around plans Delta Dental rolled out in 2013 to reduce reimbursement rates by 8% to 12% for its Premier network of dentists. CDA claimed this was a breach of the insurer's "duty of good faith and fair dealing" and that Delta Dental had not "fairly and adequately" given notification of the proposed reduction.
“We told our members we would go to the mat for them and that's exactly what we did.”
— CDA President Natasha Lee, DDS
CDA filed an arbitration claim in August 2013, which was followed by a lawsuit in California Superior Court in June 2014. The focus of both the arbitration and the lawsuit was the insurer's actions around its participating dentist agreement (PDA), which Delta Dental required for dentists to be a part of the Premier network. The CDA challenged some of Delta's amendments to the PDA and its calculations of limitations on fees paid to participating dentists.
The insurer responded that the proposed amendments were not only permitted but were made in line with California's Knox-Keene act governing healthcare service plans. The two sides originally came to a mediated settlement in March 2017.
Specific terms of the final settlement are available on the settlement website and include the items listed below:
- Delta Dental will pay up to $65,029,299 to Premier dentists whose requests for fee increases submitted to Delta Dental were limited by the inflation adjustment percentage.
- Delta Dental will separately pay $2.35 million for attorneys' fees and expenses and incentive payments of $3,500 to each individual class representative, as ordered by the court.
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