Guardian’s Shared Network Agreement- What Does This Mean For You?

Guardian and Aetna have announced a new shared network agreement effective 2/1/15.  This may have a very big impact on many dental offices that are PPO participants.  In an effort to update as many dentists as possible, Unlock The PPO Owner, Lisa Weber, is posting on DentalTown to do an updated thread as more information becomes available.  Please visit DentalTown under the thread titled “Guardian Buys Aetna – What Does This Mean For You?” for ongoing updates as we get them.  In the meantime, find the first post on that thread below:

 

Guardian has just announced they have a shared network agreement with Aetna effective 2/1/15.  Many of you who are directly contracted with Guardian will begin to receive letters that note that you’ll be added to the Aetna PPO network through the Guardian relationship (or may be).  What do you need to look for immediately:

Do you have a direct contract with Guardian?  If so, and you do not have a contract with Aetna already in place then Guardian can now begin picking up Aetna at the Guardian rates.

Do you have a direct contract with Aetna?  If so, and you do not have a contract with Guardian already in place, you may pick up Guardian in network under the Aetna fee schedule.


Originally we were told by Guardian that they had purchased Aetna but they have since corrected that information to indicate it’s a shared network agreement only.
What recourse do you have and what steps do you need to take immediately?

Find out who you are contracted with (Guardian and or Aetna) and how you are contracted (Direct or indirect).  Gather the fee schedules that will apply.  Look at your numbers carefully.

This weekend I’ll be going through to look at the offices that we’ve worked with (enough that my headache has already begun forming) and will look at each of them because this change can have a significant impact on the collections from an office’s Aetna patient pool.

We’ll be communicating those possible changes to the practices we have worked with because this one can be a game changer as far as collections are concerned and it’s happening with virtually no notice from Guardian (or Aetna) about this change with no indication that opting out of Aetna is possible.  We’ve directed applications that have not yet been submitted to Guardian for doctors to be held pending our research on the impact to that individual practice, should they sign up.

I’ve indicated to Guardian that we will likely recommend withdrawing some applications in process and we will almost certainly be recommending that large numbers of doctors we have worked for terminate their Guardian contracts because of the impact this likely will have doctors who are in network may be huge.

I have indicated to them that the initial reaction of most is likely to put a term letter in the mail and the reps with Guardian are also just figuring out how to navigate this because it’s something that they were just made aware of and had no advance notice on as the acquisition was not finalized and was clearly kept deep under the radar even from them.

This is a new development and many of you may not have yet received letters.  As I work through the options that might be available with Guardian directly, I will update this thread throughout the process.