The Great Fee Reset

For years, many PPO negotiation companies have promised practices quick wins: a fee bump here, an extra network there, or the “easy button” of plugging in umbrella networks like Careington or Connection Dental. Most of the time, it isn’t about restructuring your contracting model—it’s about gap-filling with additional contracts to make short-term numbers look better.

At the same time, dental forums and Facebook groups have been buzzing with advice: “Drop your PPOs, pick up a high-paying umbrella like Careington, and watch collections soar.”

The problem? Carriers saw the same playbook.

They’ve begun announcing a new round of direct leasing arrangements with each other—with effective dates already on the calendar:

• DHA ↔ Cigna (effective Mar. 1, 2025)

• Aetna ↔ MetLife (effective Sept. 1, 2025)

• DHA ↔ MetLife (effective Oct. 18, 2025)

• Humana ↔ Cigna (effective Nov. 1, 2025)

• Cigna ↔ Ameritas (effective Nov. 1, 2025)

• Guardian ↔ Principal (effective Dec. 1, 2025)

And it’s not just announcements. Aetna and Guardian have already started notifying dental practices and patients of upcoming de-selections. The ripple effects are being felt at the front desk — with patients asking why their plan status is changing and offices scrambling to adjust.

These leasing deals aren’t designed to expand your options. They’re the replacement access points carriers will rely on once they officially de-select umbrella networks like Careington and Connection. The goal? Keep patients “in-network” while pulling providers back down to lower-paying direct contracts—or pushing them out-of-network altogether, shifting the financial burden onto practices and patients instead of the insurance plan.

The Forum Frenzy: Why the “Cheat Code” Backfired

Between social media “cheat codes” and PPO negotiation companies layering in extra gap-fill contracts, many practices thought they found a shortcut.

But shortcuts come with consequences. When carriers roll out new leasing arrangements, those added contracts can collapse overnight into lower reimbursements or out-of-network claims.

The result: offices are blindsided by de-selections, patients are confused, and front-desk staff are stuck explaining changes they didn’t see coming.

The S101 Difference: Strategy vs. Shortcut

Here’s the key: using umbrella networks isn’t wrong. We use them strategically every day for our clients. The difference is planning and foresight.

At Solutions-101, we don’t just stack gap-fill contracts on top of broken PPO models. We design layered contracting strategies that anticipate de-selections, enforce opt-outs, and prevent sudden collapse if carriers pull the plug.

Umbrella contracts can be powerful tools, but only if you know:

• How to sequence them against direct contracts

• How to enforce opt-outs to prevent double-stacking

• How to forecast the financial impact if/when carriers de-select

• How to prepare your team to handle patient conversations without panic

Done wrong, it’s a house of cards. Done right, it’s a strategy that protects cashflow and creates leverage for the long term.

What happens when the Reset hits?

• If you have direct contracts, expect lower cashflow as reimbursements shift back to those fee schedules.

• If you don’t have direct contracts, are you prepared to be out-of-network overnight?

• Will your front desk staff panic when patients who’ve always been listed “in-network” suddenly show up out-of-network, creating confusion and confrontation at check-in?

• Will you feel pressured to accept lower reimbursements through a direct PPO contract just to keep “in-network” status?

• Do you know how to enforce an Opt-Out — and what to do if a carrier ignores or fails to honor your opt-out request?

• Are you exhausted by the constant switching, de-selections, and new leasing arrangements that leave you reacting instead of planning?

The Bottom Line

The Great Fee Reset isn’t about cutting off access. It’s about carriers taking back fee control—replacing umbrella networks with their own leasing arrangements and forcing providers into lower reimbursements starting in 2026.

Dental forums may chase shortcuts. PPO negotiation companies may gap-fill to make numbers look good. At Solutions-101, we build strategies. We use the same tools—Careington, Connection, and others—but we use them correctly, with safety nets and compliance checks in place. That’s how we help practices protect cashflow, reduce staff stress, and maintain leverage, no matter how the carrier landscape shifts.

Don’t let the carriers dictate your next move!