In dentistry, network leasing or sharing is a mechanism in which a preferred provider organization (PPO) rents its dental network to other PPOs, such that the first PPO’s in-network dentists must unknowingly accept patients and terms as an “in-network” provider with other PPOs—even though they have never directly engaged in negotiations or agreed to the new carrier’s terms. These participating provider contracts contain a provision, which is not negotiable, that implies consent to any terms the carrier imposes, including the leasing of its provider network.
Dentists may be participating with numerous PPOs without knowing it, often unaware until they submit a claim and receive an explanation of benefits indicating additional terms and restrictions. This network leasing raises issues of transparency and lack of choice for the patient, who is unaware of their out-of-pocket financial obligations.
Key provisions of An Act Relative to Transparency of Dental Benefits Corporations:
- This legislation prohibits carriers from granting third-party access to a provider network contract or a provider’s services and contractual discounts pursuant to a provider contract.
- The legislation also prohibits granting access to dentist discounts under a provider network contract, in order to prevent the improper selling or leasing of these contractual discounts, under what is commonly known as a “silent PPO” arrangement.