MetLife PDP Plus Network Changes: The DSO Revenue Leak Nobody's Talking About

DSOs with Careington umbrella contracts are being repriced at MetLife PDP Plus rates without realizing it. The underpayment doesn't create a denial — it creates a paid claim at the wrong rate. Here's how to find it before Q2.

If your DSO has locations contracted through Careington, you may be getting paid at MetLife PDP Plus rates on MetLife claims — and you may not know it. MetLife expanded PDP Plus access agreements with Careington effective Q1 2026, meaning more locations are being routed through PDP Plus at lower reimbursement rates.

The Core Problem

The EOB will say MetLife. The payment will be at PDP Plus rates. Your practice management software records it as a MetLife claim. Unless someone compares the allowed amount to your MetLife fee schedule, the underpayment is invisible.

Scenario	Routing	Rate Impact
Direct MetLife PPO contract	Direct — no leasing	Your negotiated PPO rate
Careington umbrella, pre-2026	May route to PDP Plus	PDP Plus rate
Careington umbrella, post-Q1 2026	More likely PDP Plus	Often 5–15% lower per code

Quick Audit

3 Codes to Check First

Pull MetLife EOBs for the last 90 days and compare allowed amounts for: D0274 (4 bitewing X-rays), D1110 (adult prophy), D2392 (2-surface posterior composite). If allowed amounts vary by more than 10% for the same code at the same location, you likely have mixed routing.

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