Delta Dental class action claims company misrepresents out-of-network coverage

Delta Dental class action lawsuit overview:

• Who: Plaintiff Kevin Walsh filed a class action lawsuit against Delta Dental Plans Association, Delta Dental Insurance Company, DeltaCare USA and more than 40 Delta Dental entities.
• Why: Walsh claims Delta Dental misrepresents the percentage of out-of-network dental care it will cover.
• Where: The class action lawsuit was filed in New York federal court.

A new class action lawsuit alleges Delta Dental misrepresents the percentage of out-of-network dental care it will cover.

Plaintiff Kevin Walsh claims Delta Dental falsely represents that it will cover 50% to 100% of the cost of out-of-network dental treatment when, in reality, it covers far less than the stated percentage.

Walsh argues Delta Dental only covers a percentage of a proprietary internal price that is almost always lower than what the provider charges the insured.

“Through this scheme, Delta Dental has profited tremendously at the expense of its insureds, who are left holding the bag for often exceptionally high dental bills,” the Delta Dental class action lawsuit says.

Walsh wants to represent a nationwide class of consumers insured under a Delta Dental insurance plan who paid more for out-of-network dental care than they should have because of the company’s allegedly false and misleading misrepresentations.

Delta Dental allegedly refuses to disclose internal price to insureds

Walsh claims Delta Dental refuses to disclose its proprietary internal price to insureds, even if they ask for it, making it impossible for insured members to determine what they will actually pay for out-of-network dental services and/or products.

Walsh further argues Delta Dental’s alleged misrepresentation of its out-of-network coverage is a common practice among all Delta Dental entities across the United States, resulting in consumers paying considerably more for out-of-network dental care than they should have.

Walsh claims Delta Dental is guilty of breach of fiduciary duty and denial of benefits, violating the Employee Retirement Income Security Act. 

The plaintiff demands a jury trial and requests declaratory and injunctive relief and an award of compensatory and punitive damages for himself and all class members.

In other recent news involving a dental company, First Choice Dental agreed to pay $1.2 million to resolve claims it failed to protect consumer information during a 2023 data breach.

Did you pay more for out-of-network dental care than you should have under your Delta Dental insurance plan? Let us know in the comments.

The plaintiff is represented by Joseph I. Marchese, Andrew J. Obergfell and Israel Rosenberg of Bursor & Fisher P.A.

The Delta Dental class action lawsuit is Walsh v. Delta Dental Plans Association, et al., Case No. 1:25-cv-10801, in the U.S. District Court for the Southern District of New York.

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