Deciding whether to leave a Preferred Provider Organization (PPO) plan is a significant decision.
While PPOs have historically provided access to a broad patient base and competitive reimbursement rates, many dentists are reconsidering their participation due to shrinking profit margins, administrative challenges, and restrictions on patient care.
Pros of Leaving a PPO Plan
- Greater Control Over Fees and Treatment: Going out-of-network allows practices to set their own fees and avoid contract limitations, enabling more personalized patient care.
- Reduced Administrative Burden: Exiting a PPO can result in less paperwork, fewer claim denials, and less time spent navigating complex insurance requirements.
- Improved Profit Margins: Practices may increase profitability by collecting full fees for services instead of accepting discounted PPO rates.
Cons of Leaving a PPO Plan
- Potential Loss of Patients: Patients who prefer in-network providers for lower out-of-pocket costs may look for care elsewhere.
- Marketing and Communication Challenges: Practices must invest in clear
- Potential Loss of Patients: Patients who prefer in-network providers for lower out-of-pocket costs may look for care elsewhere.
- Uncertainty During Transition: The process of leaving PPOs can be unpredictable, with possible fluctuations in patient volume and revenue.
Additionally, some lease agreements between insurance companies and third-party administrators can automatically expand a practice’s PPO patient base, often without the dentist’s direct involvement. This may result in dentists being listed as in-network for plans with which they never explicitly contracted. Such arrangements can complicate reimbursement processes and make it harder to fully exit a PPO network.
Assessing the Impact: Burkhart’s PPO Impact Analysis Tool
To make an informed decision, analyze the financial and operational impact of leaving a PPO plan. Burkhart’s PPO Impact Analysis is a valuable resource that helps practices evaluate how dropping a PPO might affect their revenue, patient base, and overall business performance. With practice-specific data, dentists can visualize potential outcomes before making any changes.
Determining Patient Retention: Burkhart’s PPO Calculator
One of the biggest questions when considering leaving a PPO is: “How many patients do I need to retain to break even?” Burkhart’s PPO calculator tool, provides an answer by estimating the minimum patient retention required to remain financially stable while operating out-of-network. This data-driven approach empowers dental teams to set realistic goals and monitor progress throughout the transition.
Mastering Patient Care and Communication
Ultimately, the success of leaving a PPO hinges on delivering exceptional patient care and communication. Many patients misunderstand their insurance policy, not realizing that benefits can still be paid when they see an out-of-network provider. It’s up to the practice to explain this in simple, reassuring terms. Providing a pre-determination of benefits is an effective way to help patients understand their coverage and expected costs. Practices must focus on delivering value that goes beyond insurance coverage, such as personalized treatment plans, flexible payment options, and a welcoming atmosphere. When new patients call to ask if you are in-network, it’s crucial to handle these conversations with confidence and clarity. Train your team to respond in a way that emphasizes the quality of care, the benefits of choosing your practice, and the ways you help patients maximize their benefits.
Next Steps
Parting ways with a PPO plan is a complex decision that requires careful consideration of both financial and patient care factors. By leveraging tools like Burkhart’s PPO Impact Analysis and PPO calculator, and by focusing on patient retention and communication, dental practices can make the transition successfully while continuing to thrive. PST welcomes the opportunity to support your healthy business in 2026 and beyond. We are committed to your practice’s business success and the well-being of your patients. Reach out for targeted resources, an Analysis, or a strategy call with a business coach. Our support and services are complimentary to our Supply Savings Guarantee clients or clients spending 40K+ on merchandise annually.
Your success is our success. Please reach out to us anytime.
Learn more, visit the Practice Support Team page, email us at PracticeSupportTeam@BurkhartDental.com, or call 1.800.665.5323.
Category: Practice Consulting
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