By Shelley DeGroff, Founder of PPO Advisors
A big change is coming this fall that could impact your PPO reimbursements, and I want to make sure you’re ready.
Starting September 1st, 2025, Aetna and MetLife will roll out a two-way share agreement that affects how you’re connected to patients across both networks.
As the Founder of PPO Advisors, a trusted PPO management company, I built this business to bring clarity and control to PPO participation. We know these changes can feel murky, but you’re not alone—we’re here to walk through it with you and help you make decisions that serve your practice best.
What Does This Mean?
This new agreement allows Aetna and MetLife to mutually share their provider networks. If you’re currently in-network with Aetna but not with MetLife, you will automatically begin seeing MetLife patients as an in-network provider—using your Aetna contracted fee schedule.
Likewise, if you’re in-network with MetLife but not Aetna, you’ll now be able to treat Aetna patients under your MetLife terms.
This is the kind of change that directly affects how negotiating dental PPO fees works going forward—and why having a strategic PPO negotiation solution matters more than ever.
This Will Happen Automatically
You won’t need to take any action to start participating in this shared network—it will happen by default. However, if this setup doesn’t make sense for your practice, you’ll need to opt out manually.
We can help with that, and I encourage you to reach out if you’re unsure whether opting out is the best move for your practice.
Pay Close Attention to Fee Schedules
Whether you’re working through a direct PPO negotiation or using umbrella networks, one thing remains true: fee schedules drive revenue.
If you’re in-network with one of these carriers directly and the other through an umbrella, the determining factor for your claim payment will likely be the lower of the two fee schedules. That’s why it’s critical to monitor your Explanation of Benefits (EOBs) closely.
Many practices miss this detail, only realizing later that they’re being reimbursed at a rate far lower than expected—especially if the umbrella fee schedule is driving payment.
Understanding how negotiating fee schedules with insurance companies works in this environment is key. Don’t just accept the defaults—be strategic.
Our Guidance
At PPO Advisors, our mission is to simplify the complex and help you get paid what you deserve. We specialize in PPO negotiations that align with your financial goals—without compromising network participation.
With this upcoming change, we’ll be helping our clients to:
👉 Analyze current and potential PPO fee schedule impacts
👉 Determine if opting out makes strategic financial sense
👉 Track reimbursement trends through your EOBs
👉 Keep you profitable and positioned for long-term success
We believe that a smart, data-driven approach to PPO negotiation is what transforms PPO participation from a liability into an asset. That’s how we help our clients turn PPO into profit.
Bottom Line
Changes like this can feel overwhelming—but you don’t have to navigate it alone. PPO Advisors are here, in your corner, doing the deep dives so you don’t have to.
If you’re unsure how this will affect your reimbursements or want help creating a strategy that protects your practice, reach out. We’re ready to help you evaluate your options and make informed decisions that support your success.
Thank you for trusting us to be your partner in PPO solutions and smart PPO management. Don’t hesitate to Contact Us with your questions.