PPO insurance strategies every dental practice must understand to thrive

In 1994, 43% of the US population had dental benefits. Today, approximately 87% of Americans have a dental benefit.¹ This increase has had a profound impact on dental practices, namely that it’s no longer optional to understand and strategically manage PPO dental insurance; it’s essential.

Dental insurance has become a cornerstone of dental economics. The incredible growth in coverage has changed everything. Patient behaviors, practice operations, and practice profitability are heavily influenced by managed care.

The prevailing mindset that PPO participation offers a competitive edge by helping dentists attract patients is outdated. The average dentist is listed in more than 26 PPO directories.² The reality is that participating in PPOs simply levels the playing field. As a result, without a deliberate strategy, PPO participation can erode pricing power, create confusion among patients and staff, and cut into profitability.

What is a PPO participation strategy?

A PPO participation strategy or payer contracting strategy is a structured approach to help you decide whether to participate, with whom, and how. This is done through a careful review of your practice in your market with available insurance networks. Negotiating reimbursements alone is not a strategy, but one of the many tactics used to inform and define your overall participation strategy.

Hamlet’s famous inquiry, “To be or not to be?” is relevant yet again when deciding whether your dental practice should participate in-network. While there are not enough patients to satisfy an industry full of fee-for-service practices, dental practices can be successful in either model.

If PPO participation is the right approach for your office, then you must answer the question of which networks and how to participate. It can be complicated to select the networks in which to participate. PPO participation largely levels the playing field, facilitates patient attraction and retention, and removes barriers to treatment acceptance. Market research and fee schedule negotiations are helpful tactics, but network leasing plays a major role in finalizing any payer contracting strategy.

What is network leasing for dentists?

Network leasing is where one dental network leases access to its roster of contracted providers to other networks. With one application, dental practices can quickly access dozens or even hundreds of dental networks, employers, and third-party administrators as a preferred provider.

A recent example is the leasing of MetLife’s PDP network. MetLife has a growing list of agreements, including with Aetna, Ameritas, and Guardian. This practice has grown exponentially recently, though it started decades ago.

DenteMax was formed in 1985, offering national provider access to payers that wanted to supplement their networks or didn’t want to build one at all. Today, leasing is widespread and often invisible to providers. Nearly every major payer uses leasing in some form, with Delta Dental being a notable exception.

While network leasing offers administrative convenience, broad patient access, and the potential for rate arbitrage, it also creates a tangled web that can blur the lines of participation and undercut your profitability.

Network leasing can turn a single PPO agreement into 10, 15, or even 100-plus participation listings. That might sound like a growth hack with access to more patients and more plans, but it also comes with its challenges.

As network leasing evolves, leased partners can and do change and even overlap. For example, United Concordia has multiple leased arrangements. In practice, a provider who participates with Ameritas, DenteMax, Humana, and Principal will be shared with United Concordia four times.

Thus, United Concordia will have the option to pick how the company wants to access this provider. This selection process is proprietary and known as a stack ranking of leased partners. Yet, many of these partnerships have exclusions. Some are state-specific, while others are limited by specialty or limited to specific plans (meaning not all patients will be considered in-network).

Lastly, leased partners are not required to pick you up via leased arrangements.

Preparing your dental team for success

Request full disclosure: When signing any PPO agreement, ask for a list of leased partners. Some carriers will include this with the enrollment booklet, but you’ll often need to request it separately. Many are also available on payer portals.

Build a master participation tracker: It’s important for a team member to be responsible for building and maintaining a spreadsheet to track the following:

• Each PPO for which a provider is directly contracted
• Leasing partners associated with each payer
• As claims are paid, which payers are associated with which lease agreement. For example, if Guardian claims are paying off the MetLife fee schedule, note it on the tracker. 
• An updated practice management system to tie that fee schedule to the appropriate covered plans
• Multiple providers as they may be contracted inconsistently based on a variety of factors

Many practices lose thousands of dollars in revenue each year due to a lack of visibility into leased network activity. To protect profitability and practice growth, dental practices must treat PPO participation and network leasing as a strategic business function.

Unlike days of old, practice owners cannot set a payer contracting strategy and then forget it. A practice’s payer contracting strategy should be reviewed annually to account for changes in the market and changes within your practice.

Prepare your dental team for success

Navigating this landscape begins with awareness and continues with active management. Here are actionable steps to protect your practice:

Active monitoring: Appoint a responsible team member to set aside time regularly to review:

• All mail and electronic communications from payers (mail and electronic). Be sure to register for payer newsletters.
• Payer portals for updates
• Benefits and eligibility checks that include collecting fee schedule information and verifying provider contracting status

Train your team: Ensure your front desk and billing staff know:

• How to verify in-network status, including leased arrangements
• How to verify fee schedules for a patient's plan
• How to educate patients clearly about expected out-of-pocket costs and network participation

Build relationships with payer reps: A good contact at each network can help resolve disputes, clarify participation, and even provide a heads-up on changes before they go public.

From treatment coordinators to front desk to billing and even hygienists, your entire staff needs to understand the impact of network leasing. This ensures patients receive accurate information, and the practice can avoid costly mistakes or missed revenue opportunities.

Build a strategic insurance plan

Knowing your participation and associated fee schedules is the first step. However, practices that thrive take a data-driven, proactive approach to PPO management and, as a result, can take their practice to the next level. That includes:

• Map participation across direct and leased networks to understand the true scope of your insurance participation. Review annually or as needed based on claims audits or network announcements.
• Routine PPO reviews and renegotiations. Most PPOs ask for a two-year commitment to a fee schedule. Track these dates and be prepared to renegotiate to ensure you’re not stuck with outdated or below-market rates.
• Leverage third-party tools or consultants (like Five Lakes or Credentialing DDS) who specialize in the nuances of leasing, credentialing, and reimbursement optimization.
• Identify opportunities for direct contracting where it benefits the practice. Direct contracts are often preferred to avoid headaches.
• Understand the opportunity and impact of opting out of network leases.

The business of dentistry

According to the ADA Health Policy Institute, doctor reimbursement is down when adjusted for inflation.³ Similarly, insurance reimbursements are not keeping pace with inflation. Meanwhile, the industry is consolidating, salaries and other costs are rising, and network leasing arrangements are reshaping the insurance landscape. The business of dentistry and your revenue cycle have never been more important. Active management is key to maintaining control of your pricing power, patient mix, and profitability.

PPO participation is important to most practices, yet it is becoming increasingly complicated. Network leasing adds layers of complexity, but these complexities create opportunities.

By mastering the mechanics of network leasing, tracking your participation, aligning your team around enhanced benefits and eligibility verification processes, and contracting practices, you can succeed in a PPO world.

Author's note: This article was written with the assistance of artificial intelligence.

References

1. NADP reports dental benefits market is stabilizing after pandemic-era disruptions. NADP. July 1, 2025. https://www.nadp.org/nadp-reports-dental-benefits-market-on-road-to-recovery/

2. 2024 State of the Dental Benefits Market. NADL. July 2024. https://www.nadp.org/research/2024-state-of-the-dental-benefits-market/

3. Update on net income of general practitioner dentists – 2023 data. American Dental Association. May 2024. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/net_income_general_practitioner_dentists_2023.pdf

Editor's note: This article appeared in the October 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.