Understanding the New Two-Way Agreement Between MetLife and Guardian Effective June 1, 2024

Starting June 1, 2024, a significant shift in network agreements will take place between two major insurance networks, MetLife and Guardian. This blog post from PPO Advisors delves into the specifics of this new two-way agreement and its implications for providers. Whether you’re directly contracted with MetLife, Guardian, or associated with umbrella companies like Connection, Denimax, or Carrington, understanding the nuances of this arrangement is crucial for maintaining optimal fee schedules in your practice.

What is the New Agreement?

Effective from June 1, 2024, MetLife and Guardian will implement a reciprocal network-sharing agreement. This arrangement ensures that if a provider is in-network with Guardian, they will automatically be recognized as in-network with MetLife and vice versa. This change aims to streamline provider networks and enhance the accessibility of services for insured clients.

Key Details of the Agreement

Direct Contracts: Providers with a direct contract with either MetLife or Guardian will be recognized as in-network by the other, based on the originating contract’s fee schedule. This mutual recognition helps in reducing administrative burdens and simplifying the insurance claims process.

Impact on Providers Using Umbrella Companies: For those providers who operate under umbrella networks but also hold direct contracts with MetLife or Guardian, it’s crucial to note how fee schedules may adjust. If the direct contract’s fee schedule is lower than that of the umbrella company, the lower fee will most likely prevail. Therefore, providers need to be vigilant about their contractual agreements to avoid unintended reductions in fees.

Providers who hold direct contracts with both networks will likely not see any change, but to watchful of the Most Favored Nations clause sneaking in at some point if one network has lower fees than the other.

Steps to Take Before June 1, 2024

Contract Review: Thoroughly review your existing contracts with MetLife, Guardian, and any umbrella networks. Understand the fee schedules associated with each to identify any potential discrepancies.

Organize Stacking Order: Establish a clear stacking order for your contracts. This strategy will help in prioritizing higher fee schedules where possible and prevent defaulting to lower fees.

Seek Expert Advice: Consider consulting with insurance network specialists like PPO Advisors to navigate the complexities of these changes. Expert guidance can aid in optimizing your contracts and securing the best possible outcomes for your practice.

The upcoming agreement between MetLife and Guardian represents a significant development in the insurance industry, impacting many providers. By preparing in advance and strategically organizing your contracts, you can ensure that your practice continues to operate smoothly and profitably under this new arrangement. Stay proactive and keep an eye on the developments as June 1 approaches, ensuring you adapt effectively to these changes.

Don’t wait for the changes to catch you off guard. Contact PPO Advisors today to review your contracts and prepare your practice for the new MetLife and Guardian two-way agreement. Ensuring your fee schedules are optimized before the agreement takes effect can save you from potential disruptions and financial setbacks. Be prepared, be informed, and confidently take charge of your professional future. You can contact us here.

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