California Dental Health Plan Dentists Right to Fair Procedure Regarding Fees
In Delta Dental Plan v. Banasky (1994), 27 Cal. App. 4th 1598, fair procedure principles were applied to a dental health plan's decisions regarding usual, customary, and reasonable fees to be paid to participating dentists for their services.
The plan's agreement with the participating dentists provided for internal review of such fees only; it did not provide for arbitration or judicial review, as requested by the dentists. (Id. at pp. 1601-1602.)
The court concluded:
"Delta controls an important economic interest as the largest dental health plan in California, covering over 8,000,000 individuals.
Therefore, continued membership on Delta's panel of participating dentists, and Delta's modification of a participating dentist's list of usual, customary and reasonable fees, implicate the right to fair procedure." (Id. at p. 1607.)