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It’s time to fire the PPOs

June 1, 2021
It's no secret that PPOs can be more of a pain for dental practices than they're worth. Getting rid of some of them may actually help your practice become more profitable.

Insurance companies hurt your cash flow, damage your profit margins, and jeopardize your patients’ experiences with your office. If I had a partner or employee who did this to my business, I would fire them.

Practices can obviously make money when they join a PPO, but this makes running your business a challenge as the PPO eats up precious staff time and confuses patients. I believe there is a better and more profitable way to run your practice: strategically: fire the PPOs!

Follow these steps to ensure that you have the most success.

Negotiate your fees

One of the first things you should do when firing PPOs is negotiate your fees so that you can optimize the revenue stream. According to Ben Tuinei, president of Veritas Dental Resources, “A practice can gain back hundreds of thousands of dollars a year if it just takes the time to negotiate the PPO fees. Negotiating fees is an art, its true, but it is definitely a strategy that practices should consider to help them become more self-reliant.”

Learn verbal skills

If your staff doesn’t learn how to speak to patients, then this may be a big challenge when trying to move away from PPOs. I suggest reading the book Never Split the Difference, by Chris Voss, to help your team learn negotiation and verbal skills, as well as basic sales skills. I also recommend taking Voss's master class course on negotiation.

Voss says, “Life is negotiation. Learning how to sell and negotiate is one of the greatest skills, especially when you are speaking with your patients about going out of network.” Without question, verbal skills are important tools that any person can develop. Whether you’re speaking to one person or a group, your ability to communicate effectively will determine how influential and successful you are. The power of your presentation will dramatically affect your results regarding cutting out PPOs.

The power of positive communication

People are attracted to positive people. Even better, the effect is contagious. When talking to people about “going out of network,” speak positively and believe that the patients will respond positively to the situation. If you don’t believe that cutting out PPOs will benefit the practice and patients, you’ll start off on the wrong foot, and mindset matters. Instead of talking about going out of network, say you have become an unrestricted provider, and this allows you to give your patients the highest quality of dental care. There are many ways to speak positively about going out of network.

Start a dental membership program

A dental membership program can help increase patient loyalty, generate predictable recurring revenue, cut out PPOs, and increase case acceptance by two-and-a-half times. A dental membership program is similar to Amazon Prime in that patients pay a monthly or yearly subscription fee to gain access to certain benefits and savings designed by your practice. When you design your own benefits and pricing discounts, you’re in control of your profit margins. When you’re in control, you can make the best decisions for your business and patients without a third party involved.

Practices that grow strong membership plans enjoy recurring revenue whether they do dentistry or not. Recurring revenue will help a practice’s cash flow cycle, as this is one of the most important components of running a business. Another great benefit of a membership plan is cash control, meaning you can set the subscription billing dates for the first and 15th of each month, right before payroll, so that you have a cash infusion. This will lead to less stress and will make sure your team morale stays positive as they receive their paychecks on time.

Membership plans also create a patient retention system. This is critical as you leave the PPOs behind. Uninsured patients are good candidates for membership programs. There are over 100 million Americans without dental insurance,1 and most of them believe they can’t see a dentist because they “don’t have insurance.”

Turn on the marketing engine

If you’re serious about going out of network and starting a membership plan, then you need to market and promote your practice. There are many marketing channels, such as referral marketing, online ads, online content marketing, social media marketing, direct mail, and more. If you don’t know which channel can drive results to your practice, I suggest picking one, such as Facebook ads, and focusing on that channel.

Tips to fire PPOs

1. According to Bill Rossi with Advanced Practice Management, you have more power than you think. Patients do not come to you based solely on the PPOs you have. You have the power to build relationships and influence people, and this will help you become self-reliant.

2. It is important to find the right balance of PPO participation. When a dentist has complete control over his or her fees, balance is essential so that the fees are not too high or too low. This is where in-house membership programs can be helpful for practices that want to become more fee-for-service oriented.

3. It can be dangerous to cut all PPOs all at once. Consider trimming back a little and then marketing your new membership program. After youve done this successfully, cut more PPOs as you become comfortable and established with your in-house membership.

4. According to Tuinei, it’s wise to look at each PPO that you’re contracted with and then look at the out-of-network payouts. You can optimize your revenue stream by examining each one, and this will also help you develop your verbal presentation for each segment of patients under that PPO.

The purpose of looking at out-of-network benefits is to avoid surprises. Often when insurance plans reduce benefits out of network and you’re not aware of this, you’re not able to develop proper expectations for your patients. They want to have a conversation focused on quality clinical care and not solely on insurance benefits.

If you follow these ideas, your office will be more profitable, easier to manage. and more enjoyable. Don’t fear cutting out PPOs! Most practices that have are extremely grateful. They offer better patient experiences and are paid what they’re worth!


1.  Heltz D. The sorry state of dental care in the United States. Healthline. Updated September 7, 2017. https://www.healthline.com/health-news/the-sorry-state-of-dental-care-in-the-united-states-101814

JORDON COMSTOCK is the founder of BoomCloud Apps, a software company that allows dental offices to easily create, organize, track, and automate an in-house membership program. You can download a free e-book about membership programs or watch a free demo. Contact him at (801) 753-8586 or [email protected].

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