A U.S. class action lawsuit has been filed against Delta Dental Plans Association and 40-plus affiliates, claiming they widely misrepresent coverage for out-of-network dental services to insured patients, according to a story published on January 14 in Top Class Actions.
Kevin Walsh, who filed to represent a U.S. class of Delta Dental insured patients, filed the lawsuit in U.S. District Court for the Southern District of New York claiming that the insurer's false and misleading representations leave patients footing the bill for much higher out-of-pocket costs than they expected to pay, according to the story.
The lawsuit alleges violations of the U.S. Employee Retirement Income Security Act (ERISA), including improper denial of benefits and breach of fiduciary duty. Walsh is seeking a jury trial as well as compensatory and punitive damages.
In the lawsuit, Walsh alleges that Delta Dental promotes that its plans cover between 50% and 100% of the costs for dental services rendered out of network. However, Delta Dental allegedly only pays a portion of that percentage, which is listed in a proprietary internal schedule. That price is routinely less than dentists’ bill rates instead of a percentage of what clinicians charge, according to the story.
Furthermore, the suit claims that Delta Dental will not provide its internal pricing schedule to the patients it insures, even when requested. Walsh argues in the suit that without Delta Dental’s internal pricing, patients cannot accurately calculate how much they can expect to pay for dental treatment before they receive it from an out-of-network provider, according to the story.
The lawsuit alleges that Delta Dental engages in this practice knowingly and with the intention of limiting reimbursements by misleading its insured members. Moreover, the suit claims that Delta Dental’s entities throughout the U.S. engage in these practices, forcing insured patients nationwide to pay much more for out-of-network dental treatment than necessary.
