Umbrella network changes today that will impact you tomorrow

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Intro: You are now listening to another episode of the Insurance Untangled podcast, where we explore the various challenges faced by dental practices due to their reliance on insurance. Join us in this podcast as we dive deep into the issues surrounding dental insurance dependence and offer practical solutions and strategies to help you take control of your practice’s financial future.

Ben Tunei: So, let’s start, uh, first by talking about what is an umbrella network. Well, "umbrella network" is a phrase that I coined way back in 2007 and, um, I don’t know if I was the first one to, to, to say "umbrella networks." Being the first to start a business of this type—PPO negotiations and credentialing in the industry—I always called dental networks like Connection Dental, Carrington, Ax, or even Maret or Zeus, I always called them umbrella networks.

Um, but they’re officially called leasing networks, which essentially— you know, like a DenteMax or a Connection Dental— they don’t actually sell dental plans. They just recruit doctors, they set a fee schedule, and have a provider agreement. They recruit doctors, and then they package that list of providers and sell it to other insurance companies. And that’s how other insurance companies are able to have a much more robust list of in-network providers.

Ben Tunei: Uh, when they struggle to recruit providers on their own, the easy path is to contact DenteMax or Connection Dental and say, "Hey, can I pay you a fee so that I can lease your in-network doctors so that they’re now on my list as in-network doctors?" And then, when we pay claims, we’ll pay whatever network fee schedule agreement that you have with that doctor.

So that’s a leasing arrangement. It has very little to do with you as the doctor, but it has more so to do with access and giving insurance companies or brokers that are selling dental plans the ability to tell an employer, "We have a lot of in-network options for your employees to go to." That is why umbrella networks exist— to increase the access to in-network providers.

So historically, when you look at umbrella networks, the vast majority of the time—like, let’s say you want to contract with an Aetna or Cigna—historically, when you go through the umbrella networks, you get a way better fee schedule.

Ben Tunei: And so, because of that, what you’ve seen over the last decade is these umbrella networks competing against each other on fees, right? Trying to entice the next set of doctors to enroll. And how do you do that? You increase your fees. You increase your recruitment fees.

So, it’s not uncommon these days to see doctors that credentialed with a certain umbrella network way back in 2017, and doctors today that are credentialing with that same dental network are getting lower fees. So that is what’s— that’s what’s playing out right now. A lot of umbrella networks, they— well, some of them were too aggressive with setting their fees, and naturally, they started to lose contracts, right? PPOs that used to lease these networks were saying, "Your fees are too high, so now we’re gonna cancel our agreement. We’re gonna go to the other umbrella networks that have lower fees."

Ben Tunei: So, you see that play out. But the funny thing that happens is that these insurance companies say, "Hey, I’m not gonna pay you that fee anymore to lease your network because your fees are too high." And then, a year later, they re-enroll with that same umbrella network. And so, they cycle through these umbrella networks.

And, and I think most of the realization among these insurance companies, as it pertains to the decision to opt out of an umbrella network relationship, is the fact that the doctors aren’t going in-network directly with those plans. So, so let me— let me break that down.

So, you have Insurance Company A. It leases with Umbrella Network Company A. And then Insurance Company A decides, "We’re going to kick out Umbrella Network Company A. We don’t want to partner with Umbrella Network Company A anymore." And Insurance Company A— they do that because they want to force doctors to go in-network directly to take a lower fee schedule.

Ben Tunei: Well, doctors are not doing that. Doctors are not flocking to these insurance companies to take lower fees. Nobody’s—well, very few doctors are doing that. So what happens is that the insurance company, they look at that data and they have to make a decision: do we want to continue paying higher out-of-network fees, or would we rather get some type of discount by honoring the next-level umbrella network fee schedule that we can lease, right?

So you’re seeing all these insurance companies going back to those relationships ’cause they have no choice. And thanks to those that are staying out of network with these PPO contracts, that’s what’s helping to correct the fee schedule issue that every one of us is—well, you all, all you doctors are—experiencing across the country.

So, umbrella networks are not easy. They’re not straightforward. Every month you’re gonna get an opt-out—or, sorry, you’re gonna get a new announcement—uh, between two insurance companies partnering together.

Ben Tunei: Like, we— we’ve seen this year, um, Cigna and Dental Health Alliance— they also go by Assurance or Sun Life. So, Cigna and DHA, MetLife and DHA. So you’re seeing all these relationships. Ameritas, Principal, Aetna— all of them are making moves.

And yet, this— I just reviewed a Delta Dental agreement, um, in certain states, and their agreements are written like umbrella network companies. And so, it looks like Delta is going to lease their network out to the PPOs that currently use umbrella networks. And so, stay tuned on that. We’re following that, and we’ll let you know, and we will report on how that’s gonna impact the industry.

But I wanted to do a quick episode to kind of explain umbrella network situations. If you are getting announcements from insurance companies, um, there are activities that you need to do. Number one, if you get an announcement between, let’s say, DHA and MetLife, and— and let’s say you’re directly contracted with MetLife but your DHA fees are higher, I would investigate that.

Ben Tunei: I would find out, "Okay, what patients underneath MetLife would be included as in-network under my DHA agreement?" Right? Um, and then, if everything looked good, you can cancel your MetLife contract. This is how it’s usually done: you cancel your MetLife contract, and then it’s up to MetLife to renew you under DHA. And they— they do, almost all the time. There are some situations where they don’t, so it’s a risk. It’s a risk for you. But to me, it’s a— it’s a good risk because MetLife would rather have savings by paying you a discounted umbrella network fee schedule compared to paying you your full office fee, right?

Because MetLife, on— on a lot of their employer accounts, they pay your full fee if you’re out of network, or at least they allow your full fee. So if you charge $350 for a hygiene appointment, whereas in-network you’d only get $110 or $120, out of network, you’ll get $350. Right?

Ben Tunei: If that’s your full office fee— uh, on a lot of claims— and so, when you do the math, out-of-network for most, if not all, dental plans is— in-network is significantly less expensive for the insurance companies. And so, that’s why they do these leasing arrangements.

Um, so if you have— if you have trouble with these leasing arrangements or have questions, give us a call. Like, give me a call, reach out to me, ask your questions. Uh, or you could request a complimentary, uh, analysis, and we’d be happy to do that. Just mention that you heard this on the, uh, Insurance Untangled podcast and we’ll give that to you complimentary.

Uh, but check out our website— uh, sorry— www.veritasdentalresources.com

Ben Tunei: Don’t ignore them when they come through. These umbrella network changes are designed to trick you into taking lower fees. Let’s reverse engineer that strategy and let’s make it work in your favor.

Uh, so that’s my message for today, and I hope— I hope, uh, all of you would— would— would do more research on this. We’ll do more episodes on this in the future, but again, if you have questions, visit our website, which is posted in the show notes. And, uh, you know, I just want to make sure that our listeners have the best guidance and advice, especially on this whole complex world of umbrella networks.

We’ve only scratched the surface in terms of the current changes, but there’s a lot that’s going on and a lot that could impact your practice negatively, but also positively. So, um, talk to us, reach out to us, ask questions.

Uh, let’s just make sure that you have the right setup and the right direction, as well as the right feedback. And if there’s a specific episode that you want us to record on umbrella networks, just send us your questions, and of course, we’ll— we’ll— we’ll continue to kind of build a series surrounding this topic because it’s an important one.

Folks, thank you for joining us today on another amazing episode of the Insurance Untangled Podcast. Uh, if you like this, share it, like it, uh, give us some love. Allow other doctors to find this content. I feel like this content is important as we head into 2026, where it’s rumored that we’re gonna see a lot more changes within the insurance industry slash dental industry at the same time.

So, keep us informed on changes you see, and I promise we’ll report on solutions that we find to those changes. But until we meet next time— again, folks— I wish all of you the best of success.

Take care now.