Several dental plans including Delta Dental are reducing fees, some rather significantly. According to Gray Robinson (GR), our legal/legislative representatives, the practice’s rights will be governed by their Participating Provider Agreement with Delta Dental (or whoever the plan provider is). GR has negotiated these fees for some of our dental practice clients, but negotiates for a minimum of 120 days notice to change rates, in order to give the provider the right to terminate prior to the rate reduction if it is unacceptable to them. The standard proposal, however, coming from the plans is typically a unilateral right to change rates with 30 days notice, and which does not give the Provider any additional right to terminate other than the existing termination rights under the current term of the agreement.
As for Delta Dental, GR related that they have a reputation for this behavior on the west coast and seem unthwarted by lawsuits and judgements against them. According to GR, it seems that they are now carrying over the practice to the East Coast.
To have leverage to negotiate better terms and maintain rates, GR suggests that dental practices exercise whatever rights they have to terminate and go from there. It puts the practice in an uncomfortable position of potentially losing patients because the dental practice is suddenly out of network for, but necessary to have negotiating leverage. Otherwise, the practices risk more unilateral reductions year after year if not able to take that stance.
Links regarding the west coast litigation:
- https://adanews.ada.org/ada-news/2023/january/california-dental-association-files-legal-action-against-delta-dental-of-california
- https://dentalbilling.com/cda-wins-3-%C2%BD-years-battle-delta-cannot-reduce-premiere-plan
GR is not sure if there is a particular threshold, but believes Dental Plans may have to give notice or get approval of the Florida Office of Insurance Regulation (FLOIR) to make significant reductions. That may be another avenue to push back if FLOIR should be reviewing or approving these reductions.