A dentist in Mississippi has filed a class-action suit against Delta Dental plans and the Delta Dental Plans Association, accusing the largest dental insurer in the U.S. of fixing prices and conspiring to reduce the amounts paid to clinicians.
The suit, filed December 11 by William Dickey III, DMD, of Big River Dental in Brandon, comes two weeks after the ADA filed its own class-action suit against Delta Dental, claiming uncompetitive conduct. Dickey, who filed his antitrust lawsuit in the U.S. District Court for the Southern District of Mississippi, is one of about a dozen individuals suing various Delta Dental brands, claiming similar allegations.
"Dr. Dickey was deprived of the choice of accepting dental patients under the greater number of insurance plans that he would have been able to choose from in a competitive market and was reimbursed less for providing dental goods and services than he would have been but for that anticompetitive conduct," according to the suit.
Currently, the Delta Dental is the leading dental care insurer in the U.S., serving more than 80 million Americans, and 1 in 3 Americans is insured through Delta Dental, while 3 out of every 4 dentists in the U.S. are part of the Delta Dental system, according to the suit.
In a nutshell, the suit alleges that Delta Dental, which operates in every state in the U.S., functions as a conglomerate instead of separate entities.
For example, the suit notes that the plans are not only members of the Delta Dental Plans Association, but they also govern the association. Its member plans, all of whom are independent insurance companies or affiliates of those companies, completely control the association. The plans control the association's board of directors, which are comprised of presidents and CEOs of the Delta Dental plans. However, the association promotes this group of independent companies as a single provider Delta Dental, according to the suit. Since the plans elect the board and appoint the officers of Delta Dental Plans Association, as well as vote on any major actions of the association, the plans have control over its major decisions, Dr. Dickey alleges.
Furthermore, the dentist claims that Delta Dental has participated in anticompetitive conduct and violated federal antitrust laws by allocating territories of operation and dividing the U.S. market to restrict competition and lower reimbursement rates to clinicians. Also, he alleges in the suit that Delta Dental's actions harm dentists and their patients.
"Delta Dental's practices will continue to undercompensate dental providers who are part of its network and will result in harm to patients," according to the suit.
Dr. Dickey, other dentists who have sued, and the ADA are requesting that the court certify the proceedings as a class action.
No matter which party wins, many believe these lawsuits and their effects will have a dramatic impact on carrier/provider relationships.
Last month, insurance expert Teresa Duncan of Odyssey Management, broke down what these types of antitrust lawsuits against Delta Dental could mean to the dental industry and individual clinicians. You can hear her take on the issues in this in-depth podcast.
