A new federal class action lawsuit alleges that Delta Dental Plans Association and more than 40 affiliated Delta Dental entities systematically mislead insured patients regarding the extent of coverage for out-of-network dental care. The lawsuit was filed in the U.S. District Court for the Southern District of New York by Kevin Walsh, who is seeking to represent a nationwide class of Delta Dental members.
According to the complaint, Delta Dental markets its plans by stating that it will cover between 50 percent and 100 percent of out-of-network dental services. In reality, the lawsuit claims Delta Dental does not pay a percentage of the dentist’s actual charge. Instead, it pays a percentage of a proprietary internal pricing schedule that is almost always lower than providers’ billed rates. The result is that patients are left with significantly higher out-of-pocket costs than they were led to expect.
The lawsuit further alleges that Delta Dental refuses to disclose its internal pricing methodology to insured members, even when they specifically request it. Without access to the internal price used to calculate reimbursement, patients cannot determine their true financial responsibility before receiving out-of-network care. Walsh claims this lack of transparency is deliberate and central to how Delta Dental limits payouts while presenting coverage in a misleading way.
Walsh argues that this practice is not limited to a single plan or state but is used consistently by Delta Dental entities nationwide. He claims that insureds routinely pay far more for out-of-network dental care than they should have, given how Delta Dental represents its coverage.
The lawsuit alleges violations of the Employee Retirement Income Security Act, including breach of fiduciary duty and improper denial of benefits. The plaintiff is seeking a jury trial, declaratory and injunctive relief, and compensatory and punitive damages on behalf of all affected class members.
The case is Walsh v. Delta Dental Plans Association, et al., Case No. 1:25-cv-10801. Walsh is represented by attorneys from Bursor & Fisher P.A.
This lawsuit echoes long-standing concerns raised by dentists and patients alike that dental insurers routinely obscure how benefits are calculated, shifting unexpected costs to patients while advertising coverage that does not match the actual terms.
Have been struggling with the ridiculous low payments from delta Dental that seem to be less every year. Alot of disparity with what is contracted to what they actually pay. Insured patients are very frustrated. Have told them to drop delta. They are paying too much to the insurance and receiving practically nothing.
This is great news and I wish the filer all of the best. Are you aware that donations to the ADA Foundation collapsed by 92% after the ADA sued Delta? This strongly indicates that the ADA Foundation was receiving millions of dollars from Delta. It explains the NCOIL Agreement as well. As members of the ADA we were sold Advocacy. What we received was Theatre. It was a show while they took millions from insurance companies and millions from us. We need another class action lawsuit on behalf of member dentists against the ADA.