ADA Files Breach of Contract Suit Against WellPoint
The American Dental Association and three member dentists have filed suit against Thousand Oaks, Calif.-based managed care company WellPoint Health Networks and its subsidiary Blue Cross of California, alleging breach of contract, "unlawful interference" with the dentist-patient relationship and trade libel, the Wall Street Journal reports. The lawsuit, filed in U.S. District Court in Chicago, is seeking class action status (Wall Street Journal, 3/7). According to the ADA complaint, WellPoint breached its contract by failing to pay out-of-network providers' actual charges for services, instead making payments based on flawed "usual, customary, and reasonable" data. In addition, the ADA claims that language in WellPoint's Explanation of Benefits for its 2.6 million dental-plan members is "misleading" and has led dentists to "lose patients and constitutes trade libel." ADA President Dr. Gregory Chadwick said, "By regularly providing false information that casts doubt on dentists' reputations and disparages the value of dental services, WellPoint has seriously undermined the trust between dentists and their patients" (ADA release, 3/6). A WellPoint spokesperson said the insurer had not yet been notified of the suit and declined to comment on the case (Wall Street Journal, 3/7). In August, the ADA filed a similar suit against Aetna. Chadwick said, "We are putting insurers on notice not to interfere with the doctor-patient relationship because we no longer will tolerate such unwarranted interference" (Associated Press, 3/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.