Pre-Built Scenarios — Most Common Stacking Situations
Scenario 01
The MetLife Drag
You hold direct contracts with Aetna, Ameritas, and Guardian. MetLife PDP now leases to all three (2025). When any of their patients visits, MetLife's below-average fee schedule applies — not your direct contract rate. Estimated annual drag: $18,000–$52,000 for a mid-volume practice.
Est. Revenue Loss
−$35K
per year, mid-volume practice
(est. 600 affected claims)
(est. 600 affected claims)
Claim Routing — Aetna Patient Visit
Aetna member walks in
↓
Aetna checks available pathways to your practice
85%
Via MetLife PDP lease
Leasing arrangement eff. 9/1/2025
~$820 crown
SELECTED ✓
15%
Direct Aetna contract
Your actual contracted rate
~$1,020 crown
Bypassed
Revenue lost on this claim: $200 (−20%)
Aetna's fee schedule paid $1,020 for this crown. MetLife PDP pays $820. You absorb the $200 gap — invisibly.
Aetna's fee schedule paid $1,020 for this crown. MetLife PDP pays $820. You absorb the $200 gap — invisibly.
Opt-out: Use the opt-out form at dentalprovider.metlife.com/networkswap to remove Aetna from the MetLife PDP lessee access. Same form covers all MetLife lessees — you can opt out of specific carrier arrangements.
Pathway Selection Probability
When a carrier has multiple pathways to your practice, they almost always select the lowest fee schedule. Probability is weighted by estimated fee schedule differential — the larger the gap, the higher the probability of selection.
Estimated Impact — 100 Affected Claims
Carrier / PathwayExp. Rate (crown)Delta vs Direct
Aetna via MetLife PDP
85% of claims (est.)
~$820
−$200
Guardian via MetLife PDP
80% of claims (est.)
~$840
−$130
Ameritas via MetLife PDP
75% of claims (est.)
~$870
−$80
Expected loss / 100 crown claims
−$137 avg
Crown (D2750) used as reference CDT code. Actual impact varies by procedure mix. Apply estimated write-off % to your annual production mix for practice-level impact.
Scenario 02
The CDN Advantage
You're contracted with GEHA Connection Dental (CDN). Cigna joined CDN in August 2023. Ameritas joined in July 2023. Aetna MA now routes exclusively through CDN or direct PPO (eff. Sept 2025). CDN's federal FEHB fee schedule reimburses at or above commercial carrier rates — meaning patients from Cigna, Ameritas, and Aetna MA are processed at higher federal rates instead of those carriers' own (often lower) commercial schedules. CDN is a provider-favorable network.
Est. Revenue Gain
+$22K
per year, mid-volume practice
(est. 400 affected Cigna/Ameritas/Aetna MA claims)
(est. 400 affected Cigna/Ameritas/Aetna MA claims)
Claim Routing — 3 Carriers, 1 Network (Provider-Favorable)
Cigna member
Ameritas member
Aetna MA member
↓
All three route to CDN-contracted providers at federal rates
GEHA Connection Dental Network
Federal FEHB schedule — at or above commercial carriers
D2750 crown: ~$980–$1,080 (est. federal rate)
Cigna would pay ~$600 (new ~40% w/o) — CDN pays ~$1,000
+$400
Ameritas would pay ~$960 (mid-range) — CDN pays ~$1,020
+$60
Aetna MA would pay ~$850 (MA rate) — CDN pays ~$1,000
+$150
One CDN contract, three above-market revenue pathways. CDN's federal FEHB schedule is a genuine provider advantage — especially for Cigna patients, where the uplift vs. Cigna's new ~40% write-off schedule is significant.
Routing Probability by Carrier
Unlike the MetLife scenario, these carriers don't have a "choice" of pathways — they access you only through CDN. Probability = 100% for all three. The question is what percentage of each carrier's patient population routes through CDN vs. direct contract.
Revenue Gain vs. Carrier Direct Rates (D2750 crown, est.)
Carrier / PathwayCDN Ratevs. Direct Rate
Cigna via CDN
~$1,000
+$400 vs Cigna (~40% w/o)
Ameritas via CDN
~$1,020
+$60 vs Ameritas mid-range
Aetna MA via CDN
~$1,000
+$150 vs Aetna MA rate
Expected gain / 100 claims (blended)
+$200 avg
The strategy: Prioritize and protect your CDN contract. If you're contracted with Cigna directly AND through CDN, ensure CDN is positioned as your primary network for Cigna patients — the reimbursement uplift is substantial given Cigna's new ~40% write-off schedule. For Aetna MA specifically, CDN is now the primary non-direct pathway after Aetna terminated all other lease arrangements (eff. Sept 2025).
Scenario 03
The UC Quad Stack
You're contracted with Ameritas, DenteMax, Humana, and Principal — all mid-range carriers. United Concordia can access you through all four simultaneously. UC picks whichever pathway gives the lowest reimbursement. This is the exact scenario documented in Dental Economics. The Companion Life CO state filing demonstrates this with a 2-pathway stack (UC → DenteMax fallback), confirmed in writing.
Est. Revenue Loss
−$8K
per year, mid-volume practice
(all pathways mid-range — lower delta)
(all pathways mid-range — lower delta)
Claim Routing — United Concordia Patient
United Concordia member
↓
UC checks 4 available pathways to your practice
38%
Via DenteMax lease
DenteMax → UC Advantage Plus (2014)
~$920 crown
Lowest → Selected
25%
Via Humana bilateral
Humana–UC arrangement
~$950 crown
22%
Via Ameritas bilateral
Ameritas–UC arrangement
~$960 crown
15%
Via Principal bilateral
Principal–UC arrangement
~$970 crown
Revenue lost this claim: ~$50 (−5%). All pathways are mid-range — the stack exists but the fee differential is smaller. Still adds up: at 200 UC claims/year × $50 avg gap = $10,000 annual leak that's invisible without an EOB audit. Source: Dental Economics, Companion Life CO state filing.
Why Lower Probability = Lower Differential
When all pathways are mid-range, the fee differential between pathways is small (3–6%). The carrier still picks the cheapest, but the selection probabilities compress — a 38/25/22/15 split rather than an 85/15 split. The leak is real but smaller.
Probability model: each pathway's probability inversely weighted by its fee schedule rank. The lowest-rate pathway gets highest selection probability.
PathwayRate (est.)Prob-Wtd Delta
DenteMax (38%)
$920
−$50 avg
Humana (25%)
$950
−$20 avg
Ameritas (22%)
$960
−$10 avg
Principal (15%)
$970
−$0 avg
Expected loss / 100 UC claims
−$38 avg
Scenario 04
The DHA Web
You're contracted with Dental Health Alliance (Sun Life). Per the July 2025 DHA payor list, 8+ carrier groups access you via DHA — including MetLife (below-average) and Cigna (below-average). The new MetLife→DHA arrangement (eff. 10/18/2025) is the riskiest addition: MetLife's confirmed low fee schedule now applies to all MetLife patients at DHA-contracted practices. Most DHA access pathways are neutral, but two are material revenue leaks.
Est. Revenue Loss
−$12K
per year (MetLife + Cigna pathways only)
neutral carriers excluded
neutral carriers excluded
DHA Network — All Access Pathways
🏛️
Your DHA Contract
✓ NEUTRAL ACCESS
UHC / DBP (35+ entities)
United Concordia + Highmark
Humana (all entities)
Aetna (bilateral)
Mutual of Omaha
TPAs via Premier Dental
United Concordia + Highmark
Humana (all entities)
Aetna (bilateral)
Mutual of Omaha
TPAs via Premier Dental
⚠️ REVENUE LEAK
MetLife (eff. 10/18/2025)
−10–15% vs DHA rates
Cigna (bilateral)
−5–10% vs DHA rates
WellCare / Fallon (MA)
Below avg (MA dental)
−10–15% vs DHA rates
Cigna (bilateral)
−5–10% vs DHA rates
WellCare / Fallon (MA)
Below avg (MA dental)
The new MetLife→DHA deal (Oct 2025) is the change to watch. DHA-contracted practices may see MetLife patients appear — at MetLife PDP rates — without any direct MetLife contract. Check your EOBs for MetLife payment activity starting Q4 2025.
Access Pathway Risk Matrix
Not all DHA access pathways create risk. The majority are mid-range carriers at comparable fee levels. The risk is concentrated in two carriers: MetLife (below-average) and Cigna (declining, ~40% w/o on new agreements).
UHC + UC/Highmark + Humana + Aetna
Neutral
MetLife PDP eff. 10/18/2025
−10–15%
Cigna bilateral, ongoing
−5–10%
WellCare / Fallon (MA dental)
Variable
Estimated Annual Impact (DHA-contracted practice)
PathwayRisk LevelEst. Annual Loss
MetLife via DHA
High — New 2025
−$8,000+
Cigna via DHA
Medium
−$4,000+
WellCare/Fallon via DHA
Low–Medium
−$1,500+
Total est. annual DHA leak
−$13,500
Based on a practice with ~$800K production. MetLife, Cigna, and WellCare combined = est. 8–10% of claim volume at DHA-contracted practices. Apply your production mix for practice-specific estimates.
Interactive Stack Exposure Calculator
Build Your Stack — See Your Exposure
Select the networks and carriers you're currently contracted with. The calculator maps which additional carriers can access you through leased arrangements, and estimates the probability-weighted revenue impact across your claim volume.
Your current contracts
MetLife PDP
Tier 3 — Below Avg
Cigna Dental PPO
Tier 3 — Below Avg (declining)
Aetna
Tier 2 — Mid-Range
Guardian DPG
Tier 3 — Below Avg
Humana
Tier 2 — Mid-Range
Ameritas
Tier 2 — Mid-Range
GEHA Connection Dental
Tier 3 — Below Avg
Sun Life / DHA
Tier 2 — Mid-Range
DenteMax / DNoA
Tier 2 — Mid-Range
United Concordia
Tier 2 — Mid-Range
Principal Financial
Tier 2 — Mid-Range
Monthly claim volume
claims/mo
Your Stack Exposure Map
Select your contracts on the left to see your
full leased network exposure and revenue impact.
full leased network exposure and revenue impact.