Banasky

Defendants and appellants Charles Banasky (Banasky) and David G. Van Horn (Van Horn) (collectively, the dentists) appeal a judgment following a grant of summary judgment in favor of plaintiff and respondent Delta Dental Plan of California (Delta).

The essential question presented is whether Delta’s determination as to what constitutes the usual, customary and reasonable fees for certain dental procedures by its participating dentists is final and binding, or whether Delta’s internal decision is subject to judicial review by way of administrative mandamus. (Code Civ. Proc., § 1094.5.)

Because the dentists are entitled to fair procedure, they are entitled to seek judicial review of Delta’s decision. The judgment therefore is modified and as modified is affirmed.

Factual and Procedural Background

Delta is a nonprofit California corporation. It is the largest dental health plan in California, covering over 8,000,000 individuals. It contracts with dentists throughout California to provide services to patients covered by Delta dental plans. Dentists who sign such contracts with Delta are members of Delta’s panel of participating dentists.

Banasky and Van Horn are dentists…