By Shelley DeGroff, Founder of PPO Advisors
If you’ve ever had money pulled from your claim payments because of an overpayment made to a completely unrelated provider—buckle up. You’re going to like this.
MetLife just announced they’re changing how they handle overpayment recoupments. Thanks to pressure from the ADA, they’ve agreed to stop taking money from dentists who had nothing to do with the original claim.
What Happened?
Until now, MetLife had a policy where they could recoup an overpayment made to one provider by reducing payments to another—simply because the patient was the same. Doesn’t matter if the providers weren’t connected. You could literally be getting penalized for something that happened at another practice entirely.
Not only was this buried deep (if mentioned at all) in provider agreements, but it’s also illegal in some states.
The ADA pushed back in a letter, pointing out the legal and ethical problems with this policy. And guess what? MetLife listened. They’ve confirmed they’re changing the policy and will now only seek repayment from the dentist who was actually overpaid. Full implementation is expected by the end of 2025.
Why This Matters to Your Practice
Let’s talk real-world impact:
👉 No more mystery deductions. You won’t open your remittance to find a chunk missing because of something unrelated to your office.
👉 Better cash flow stability. Practices rely on predictable payments to manage overhead. This change helps.
👉 More fairness. This brings MetLife in line with what most dentists would consider basic common sense.
From My Side of the Desk
As the founder of PPO Advisors, a leading PPO management company, I’ve helped dozens of practices try to make sense of unexplained payment reductions over the years.
The common thread? No warning. No clear explanation. No fair process. This MetLife policy was a major contributor to that chaos.
To see the ADA step in and make real progress on this issue is not only refreshing—it’s powerful. It proves that when dentists speak up, and when organizations advocate with purpose, change can happen.
What We’re Watching
Here at PPO Advisors, we’ll be keeping a close eye on how MetLife rolls this out. As a team that specializes in PPO negotiation, negotiating dental PPO fees, and PPO solutions that turn PPO into profit, we’re committed to helping our clients navigate the transition and ensure payments are handled correctly—by the right party.
If you get a recoupment notice between now and the end of the year, reach out. Let’s make sure it aligns with what MetLife promised.