What the Delta Dental Lawsuits Mean For Your Practice and Your Patients

By Spiro Leunes, CPA | CEO, MRL Advisory Group – New Jersey and New York Dental CPAs

If you have felt for years that Delta Dental’s reimbursements don’t add up, you’re not imagining it, and you’re not alone.  There is now significant litigation moving through the courts on exactly that issue, and as a practice owner you should understand what’s happening, what it could mean for your collections, and how to handle the patient questions that are starting to come up. 

I want to clarify what this post is and isn’t. I’m a CPA, not an attorney, and nothing here is legal advice.  But the financial side of these cases — how these reimbursements are set, what’s being challenged, and what it could mean for your bottom line — is squarely in my lane.  So let me walk you through it the way I’d explain it to a client.

Two Different Fights, Both Worth Understanding

There are two different legal tracks, and they’re easy to confuse.  One is being pushed by patients, and the other by dentists.  They allege two different things, but they both point to the same underlying problem: how Delta Dental decides what to pay.

The Patient Lawsuit: “You Told Me You’d Cover More Than This”

A class-action lawsuit was filed on December 31, 2025, in the U.S. District Court for the Southern District of New York on behalf of patients insured by Delta Dental.  The core allegation is about out-of-network coverage.

According to the complaint, Delta tells policyholders it will cover somewhere between 50% and 100% of the cost of out of network dental services.  Plaintiffs allege that the reimbursement is not actually based on what the dentist charges, but rather on an internal price that Delta sets itself.  The lawsuit claims that Delta won’t disclose the internal number to patients when they ask for it, which makes it nearly impossible for a patient to figure out what they’ll actually owe before treatment.

If you treat out of network Delta patients, you already know how this plays out in your front office.  The patient believes they have generous coverage.  The reimbursement comes back far lower than expected, and you, not Delta, are the one standing in the room when the patient is surprised by the balance.

 

The Dentist Lawsuits: “You Suppressed What You Pay Us”

The second track is being driven by dentists, and it’s about reimbursement rates and competition.

This has been building for years.  The large federal anti-trust case – In re Delta Dental Antitrust Litigation - has been pending since 2019 in the Northern District of Illinois, brought on behalf of roughly 240,000 dentists.  The allegation at its heart is that Delta’s entities divided the market into exclusive territories and held reimbursement rates at artificially low levels, in violation of anti-trust law.

The federal case hit a procedural wall.  In September 2025, the court declined to certify a nationwide class of dentists, and the appeals court declined to take up an immediate review of that decision.  In January 2026, the trial court also declined to let the plaintiffs add state-based class claims to the federal case and the matter is moving forward on an individual basis rather than as a nationwide class.

But that’s not the end of it.  On April 30, 2026, dentists filed new class action lawsuits in California, Wisconsin, Michigan and Massachusetts.  The suits make a similar claim under state law, that Delta engaged in conduct that suppressed rates paid to dentists and limited competition in the dental insurance market.

So the short version: the nationwide federal class action didn’t get certified, but the fight has now split into individual federal claims and new state-level class actions.

Why This Matters to Your Practice Financially

Set the legal mechanics aside for a moment.  Here is why I’m telling clients to pay attention.

First, it validates what your numbers have been telling you.  When a practice owner compares their Delta reimbursements next to their fee schedule and asks “is this normal?”, the honest answer is yes, this is the market.  The lawsuits are an organized challenge to whether the market was set fairly in the first place.  Whatever the outcome, it confirms that the gap you’ve been absorbing is real and structural, and not a billing problem.

Second, the out of network issue is a cashflow and patient trust issue, not just a legal one.  If patients genuinely don’t know what their out of network coverage will produce, your treatment plans get harder to close and your accounts receivable get messier.  Patients who feel blindsided by a balance are slower to pay and quicker to leave.  That’s a real cost, and it’s one you can manage regardless of how courts rule.

Third, do not budget around a windfall.  I’ll say this plainly: do not make business decisions today based on the hope of a future settlement or a rate change.  The federal class wasn’t certified.  The state cases are new and unresolved.  These things take years, and the financial outcome for any individual practice is completely unknown.  Run your practice on the rates you have, not the rates you wish you had.

What I Would Actually Do Now

This is where I would focus your energy, because these are things within your control.

Know your true Delta numbers.  Pull your actual reimbursement data by procedure code and compare it against your full fee schedule and against your other payers.  You cannot make a good decision about any plan, Delta or otherwise, without knowing precisely what it’s paying you and what it’s costing you to serve those patients.  If you’ve never done this exercise rigorously, that is the first project.

Tighten your out of network financial conversations.  If the patient lawsuit’s core complaint is that patients can’t predict their out-of-network costs, the practices that win patient trust will be the ones that give the clearest, most honest estimates upfront.  That means setting realistic expectations before treatment, documenting what you told the patient, and not letting Delta’s opaque pricing become your reputation problem.  Transparency protects your collections and reputation.

Decide whether each plan still earns its place. As I've written before, dropping an unprofitable plan is a calm, deliberate business decision, not a rash one. These lawsuits don't change that calculus, but they should remove any lingering guilt about it. You are not obligated to participate in a fee schedule that doesn't work for your practice. Model what your schedule looks like with and without each Delta product before you decide anything.

Be ready for patient questions but stay in your lane. Patients are reading about this litigation, and some will ask you about it. You can acknowledge that you're aware of the lawsuits and that they concern how Delta calculates coverage and reimbursement. What you should not do is give patients legal advice or make promises about outcomes. If a patient wants to pursue something, the appropriate move is to point them toward the law firms handling the cases, not to position your practice in the middle of it.

The Bottom Line

The lawsuits are worth watching, but they are not a reason to change how you run your practice, at least not yet and not on speculation.  What they should do is reinforce a discipline: know your numbers, make deliberate decisions about your payer mix and protect the patient relationships and cashflow that are entirely within your control.

The practices that come through this period strongest won’t be the ones waiting on a courtroom decision.  They will be the ones who used this moment as a reason to audit their Delta reimbursements and decide with clear eyes which relationships are worth keeping.

If you want help in running that analysis, pulling your actual reimbursement data, comparing it across payers, and modeling what your schedule looks like under different scenarios, we can assist you.

Spiro Leunes, CPA

CEO, MRL Advisory Group

New Jersey & New York Dental CPAs

mrladvisorygroup.com

 (908) 731-7715

MRL Advisory Group provides accounting, tax, and advisory services exclusively to dental and medical practices, DSOs, and MSOs in New Jersey and New York. This article is for informational purposes only and is not legal advice; consult a qualified attorney regarding any litigation matter.