California Dental Assn. v. Delta Dental of California

CourtCalifornia Court of Appeal
DecidedOctober 10, 2025
DocketA170821
StatusPublished

This text of California Dental Assn. v. Delta Dental of California (California Dental Assn. v. Delta Dental of California) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
California Dental Assn. v. Delta Dental of California, (Cal. Ct. App. 2025).

Opinion

Filed 10/10/25 CERTIFIED FOR PUBLICATION

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIRST APPELLATE DISTRICT

DIVISION ONE

CALIFORNIA DENTAL ASSOCIATION et al., Plaintiffs and Appellants, A170821

v. (San Francisco City & County DELTA DENTAL OF CALIFORNIA Super. Ct. No. CGC-22- et al., 603753) Defendants and Respondents.

Delta Dental of California (Delta) is a nonprofit mutual benefit corporation (Corp. Code, § 7110 et seq.) with thousands of dentist members, for whom the main benefit of membership is the ability to enter into a Participating Provider Agreement (Provider Agreement) with Delta. Under a Provider Agreement, a dentist gains access to Delta plan enrollees as patients. In return, the dentist agrees to accept the fee payment set by Delta as full payment for services rendered. Plaintiff dentists are both “members” of Delta in its corporate capacity (Corp. Code, § 7310) and individual parties to Provider Agreements with Delta.1 They sued Delta and several of its directors after Delta exercised its right under the Provider Agreement and associated documents to make changes to future fee payments. Plaintiffs claim that in making these

1The California Dental Association (CDA) is also a plaintiff, asserting associational standing to sue on behalf of its members who are Delta dentists. For brevity, we refer to plaintiffs simply as “dentists.”

1 changes Delta violated the covenant of good faith and fair dealing implied in the Provider Agreement and certain of its directors violated fiduciary duties allegedly owed plaintiffs as members of Delta. After an initial round of challenges to the pleadings, the trial court sustained demurrers by all defendants without leave to amend. With respect to the implied covenant claim against Delta, the court ruled the company could not breach the covenant by doing what the Provider Agreement and associated documents expressly authorize it to do. As to the fiduciary duty claim against the Delta directors, the court ruled they owe plaintiffs no fiduciary duty in connection with Delta’s exercise of its contractual right under the Provider Agreement and associated documents to make future changes to its fee structure. We affirm. BACKGROUND Created in 1955 to “ ‘provide dental benefit coverage through contracts with independent professional service providers,’ ” Delta is the state’s largest provider of dental plans. It is a nonprofit mutual benefit corporation (Corp. Code, § 7110 et seq.)—meaning a nonprofit corporation created to benefit its members, not the public as a whole. It has two classes of members: corporate members and dentist members. (See id., § 7310.) Corporate members set policy and control Delta’s governing board. Dentist members enter into Provider Agreements with Delta to provide dental care to dental plan enrollees through Delta’s premier network or preferred provider organization (PPO).2

These contracts were formerly called Participating Dentist 2

Agreements. We refer to all versions of the dentist agreements as Provider Agreements.

2 The history of the instant dispute began in 2011, when Delta announced the first of two prior changes to the Provider Agreement for premier network dentists. The trial court took judicial notice of documents reflecting this history, which we now summarize. 2011 Provider Agreement and Participating Dentist Rules As of 2011, dentists joining Delta’s premier network had to execute a “[Provider] Agreement and Confidential Fee Filing Form” (some capitalization & boldface omitted) enabling them to submit a list of their fees for specified procedures. Dentists could thereafter annually submit revised fees, and Delta would “use the fees and other data to calculate allowances for claims that [the dentist would] submit for eligible patients.” Delta subsequently amended the definition of “ ‘Contracted Fee’ ” in the “Participating Dentist Rules” (Rules), which the Provider Agreement incorporated by reference. The amended Rules provided that Delta would set a maximum reimbursement limit on a premier dentist’s contracted fee (also called the “maximum amount”) by making “an actuarial calculation, and taking into account filed fees, general inflation rates, health care inflation rates, market pricing by competitors, and acceptability by customers.” The Provider Agreement, in turn, was amended to state the “ ‘maximum amount will not be reduced unless participating dentists’ filed or submitted fees decrease to such an extent that Delta . . . is warranted in reducing the maximum amount allowed.’ ” The 2013 Changes to the Participating Dentist Rules and 2014 Lawsuit In 2013, Delta gave notice of further amendments, one of which would have deleted from the Provider Agreement the limitation quoted above constraining reductions of the allowed maximum amount. This precipitated the filing of a lawsuit in 2014–a class action against Delta challenging the

3 proposed amendments and alleging that, in calculating new maximum amounts to cap premier dentists’ fees, Delta had relied not on the actuarial calculation required by the 2011 Rules, but on a study of “ ‘industry benchmark data.’ ” The plaintiffs claimed Delta thereby breached both the express terms of the Provider Agreement and incorporated Rules and the implied covenant of good faith and fair dealing inherent in the agreement, as well as violated the Unfair Competition Law (UCL) (Bus. & Prof. Code, § 17200 et seq.). The 2018 Settlement and Changes to the Participating Dentist Rules Four years later, in 2018, the parties settled the 2014 action. The settlement documents included an amended Provider Agreement and amended Rules. The changes to the Rules relevant here pertain to provisions titled, “Notice of Rules, Procedures[,] and Policies.” (Boldface omitted.) As amended, these provisions state (a) Delta “has the right to make amendments to [Provider Agreements], including these [R]ules, and any other rules, policies, or procedures . . .”; (b) “[a]ny material amendment(s) made as provided above is/are binding upon . . . participating dentists and effective 120 calendar days from the time Delta . . . mails . . . notice to the participating dentist”; and (c) “[i]f the dentist declines to be bound by the amendment(s), the dentist shall so advise Delta . . . and terminate [their Provider Agreement] within the 120-calendar day notice period.” (Underscoring omitted.) The settlement also amended the provision of the Rules governing contracted fees. As amended, the Rules state, “The ‘Contracted Fee’ is subject to and cannot exceed a maximum amount allowed as determined by Delta . . . for the eligible patient’s dental program, as well as the [dentist’s] network, specialty, and location.” (Underscoring & fn. omitted.) In addition, 4 the parties agreed Delta would delete the provision that previously stated the maximum amount “is based on an actuarial calculation, and taking into account filed fees, general inflation rates, health care inflation rates, market pricing by competitors, and acceptability by customers.” In its place, the Rules now state, “In determining the maximum amounts allowed for Contracted Fees (e.g., Premier and PPO) . . . , Delta . . . may take into account, among other things, market and competitive conditions.” (Underscoring & fn. omitted.) The Rules further state, “In the event of a decrease in Premier Contracted Fee maximum amounts allowed or levels or amounts of fee reimbursement generally applicable to Premier dentists . . . , Delta . . . will provide participating dentists . . . 120 calendar days’ notice. Such notice will [inform] each affected Premier dentist [of] (1) [their] Contracted Fees affected by the reduction(s) and (2) the potential financial impact of the reduction(s) on [their] Contracted Fee reimbursements . . . based [on their recent billing]. . . .

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California Dental Assn. v. Delta Dental of California, Counsel Stack Legal Research, https://law.counselstack.com/opinion/california-dental-assn-v-delta-dental-of-california-calctapp-2025.