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 ...
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 ...
By Shelley DeGroff, CEO of PPO Advisors As the CEO of PPO Advisors, I’ve witnessed firsthand how outdated PPO contracts can silently erode a practice’s profitability. Many providers are unaware that simply updating their CAQH profile can inadvertently recredential them into old contracts, leading to decreased fee schedules and unintended contractual obligations. The Hidden Dangers ...
By Shelley DeGroff, CEO of PPO Advisors Following the overwhelming response to our recent blog addressing the confusion around Guardian Dental’s lease affiliations with Careington and Connection, we were contacted directly by Guardian for a conversation. We appreciate their willingness to engage with us and begin clarifying the facts of this complex situation. Here are ...
The Guardian Dental Network Shake-Up: What Providers Need to Know By Shelley DeGroff, CEO of PPO Advisors Lately, there’s been a lot of noise surrounding Guardian and its relationships with shared networks and third-party lease arrangements—particularly with Careington and Connection. As a company deeply entrenched in navigating the PPO landscape, we’ve been watching this situation ...
Big News: United Healthcare & United Concordia Elite Plus — What It Means for Your Practice By Shelley, CEO & Founder of PPO Advisors If you’ve been paying attention to the latest insurance developments, you may have heard the announcement about United Healthcare’s new relationship with United Concordia Elite Plus, set to take effect in ...
Fee Schedules Too Good to Be True? What Every Dental Practice Needs to Know By Shelley DeGroff, Founder & CEO of PPO Advisors At PPO Advisors, we work with dental practices across the country who are striving to get the best possible reimbursement rates — and for good reason. Negotiating competitive fees is vital for ...
Taking the Leap: Embracing Out-of-Network Patients in Your Dental Practice Let’s face it: the phrase “Out-of-Network (OON)” can send shivers down even the most seasoned dentist’s spine. If you own a dental practice, the thought of stepping into the OON world might feel like diving into uncharted waters. But here’s the good news: you don’t ...
Attention Dentists and Office Managers! We’ve got some important news that could impact your practice starting in March 2025. Sun Life’s Dental Health Alliance (DHA) and Cigna are teaming up to combine their networks. This means that Sun Life DHA and Cigna PPO providers now have shared access to each other’s networks. Sounds like big ...
Why PPO Advisors Is Worth the Investment: A Commitment to Excellence, Results, and Transparency When it comes to PPO (Preferred Provider Organization) consulting, choosing the right firm can be a game-changer for your practice. Many firms promise quick fixes and cost-effective solutions, but what’s the real cost when you settle for the cheapest option? At ...