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 key takeaways from our discussion:
Why Providers Weren’t Notified
Guardian clarified that their contractual agreements with lease network partners prevent them from directly communicating with providers who are contracted indirectly. That means, even if a provider’s in-network status through a lease arrangement is terminated, Guardian is not allowed to notify the provider directly.
Instead, the responsibility to communicate such changes lies with the lease networks—Careington and Connection. Unfortunately, in this instance, Guardian sent notification letters to members before Connection or Careington had a chance to alert their affiliated providers, leading to widespread confusion and frustration for all parties involved.
What Providers Can Do Now
Guardian emphasized that providers who were terminated through a lease partner should first reach out directly to their lease network (Careington or Connection) and ask if they can remain in-network by agreeing to a reduced fee schedule.
However, this option may not make financial sense, as lowering your fees could impact reimbursement rates across multiple payors that access those same schedules. It’s a decision that should be weighed carefully, considering its long-term implications.
If you choose not to lower your lease network fee schedules, the next recommended step is to reach out directly to Guardian. In these cases:
👉 Providers can request a negotiated direct fee schedule
👉 And expect to be credentialed more quickly than usual
Another viable option is simply to remain out-of-network with Guardian, depending on the unique needs and strategy of your practice.
For practices uncertain about how to proceed, companies like PPO Advisors can act on your behalf to streamline this process, evaluate the financial implications, and ensure you receive timely and accurate support during this transition.
Who Was Affected?
This situation is national in scope, impacting approximately 1,000 providers so far. However, not all providers contracted through Careington or Connection were dropped.
Guardian explained that their decisions were based on a review of regional fee schedules and average discount structures. The aim, according to them, was to maintain more consistent rates across demographic areas.
Our Perspective Moving Forward
We appreciate that Guardian took the initiative to reach out and offer additional transparency around this complex issue. While the situation remains challenging for many providers, open communication is a step in the right direction, and we’re hopeful that continued dialogue will lead to more collaborative solutions.
That said, this experience serves as an important reminder for providers to carefully weigh the pros and cons of their participation choices. While going direct with Guardian may offer a path forward, it’s important to recognize that Guardian’s direct fee schedules have historically been lower than average, and for some practices, that can have a significant financial impact.
Moving forward, we encourage Guardian to continue engaging with providers directly and to consider how these changes affect not only practice operations but also patients’ access to care. We’re optimistic that this experience will inspire stronger partnerships between Guardian and its provider network, rooted in mutual understanding and shared goals.
At PPO Advisors, we remain committed to supporting our clients through this and helping them choose the most sustainable, strategic path for their practice. Stay tuned, stay informed, and don’t hesitate to Contact Us with your questions.