Big news in the dental world: Sun Life’s Dental Health Alliance (DHA) and Cigna are teaming up to combine their networks beginning in March 2025. If your practice is contracted with either (or both) of these carriers, you’ll want to take note of how this partnership might affect your contracts, patient flow, and bottom line.
What’s Changing?
- Expanded Network Access: Starting in March 2025, Cigna PPO providers will join the Sun Life DHA network. In return, DHA providers will also have access to Cigna members.
- Prioritization Details: Initially, Cigna will be placed at the “bottom of the stack” in terms of network priority. Practically speaking, this means that while Cigna providers will be integrated into DHA’s fee schedule, they’ll act as a secondary option at first.
- Fee Schedules & Patient Flow: Since Cigna’s network is becoming part of DHA’s platform, you may see adjustments to reimbursement rates and patient eligibility rules if you’re participating in both plans.
Why Should You Care?
- Financial Implications: Even small changes in fee schedules or network status can lead to significant differences in revenue. This move could influence how much you’re reimbursed for specific procedures and services.
- Patient Management: An expanded or reorganized network might mean an influx of new patients—or changes to how existing patients use their benefits.
- Contract Confusion: With any network combination, there can be a period of uncertainty around fee structures and eligibility. Practices contracted with both DHA and Cigna may find it tricky to confirm exactly which fees apply and which network arrangement is primary.
How to Prepare
- Review Your Contracts: Check your existing contracts with Sun Life DHA and Cigna. Note any clauses that mention network mergers, amendments, or renegotiations.
- Verify Fee Schedules: Contact your provider representatives or use your online portals to ensure you have the updated fee schedules.
- Train Your Team: Make sure front-desk staff and billing coordinators know about these changes so they can accurately verify eligibility and collect correct copayments.
- Seek Expert Guidance: If all of this feels complicated, you’re not alone. Mergers can create confusion, and it’s crucial to stay on top of any shifts in reimbursement or contracting requirements.
Where PPO Advisors Can Help
Navigating these network changes doesn’t have to be overwhelming. PPO Advisors is here to help with:
- Risk-Free Analysis: We’ll assess how this network merger could affect your specific contracts and revenue streams.
- Contract Negotiation Support: Unsure if you’re getting the best possible arrangement? Let us handle the fine print, ensuring you’re in the best position for profitability.
- Long-Term Strategy: Beyond March 2025, we’ll help you build a plan to keep your practice thriving amidst ongoing network changes.
Ready to Stay Ahead?
Don’t wait until March 2025 to make your move. Contact PPO Negotiation Solutions today for a comprehensive, risk-free analysis and get clear, actionable insights tailored to your practice. A little preparation now can save you stress—and revenue—down the road.