If you’re a dentist weighing whether to participate with PPO dental insurance plans, stop and read this first.

On the surface, PPOs seem like a no-brainer:

• More patients

• A full schedule

• "In-network" exposure

But the reality is far more complex. Dental insurance isn't just a marketing channel—it's a business relationship that affects every aspect of your clinical and financial success.

Before signing those contracts, let’s look at what you're really getting into—and what alternatives you should consider to protect your autonomy, profitability, and patient care.

The Pros of Participating With PPO Insurance

Let’s be fair: PPOs can offer some short-term advantages, especially for startups or new acquisitions.

1. Faster Patient Acquisition

Being listed as an in-network provider can quickly drive new patients to your practice—particularly in insurance-heavy markets.

2. Reduced Price Sensitivity

Patients are often less resistant to treatment when they believe “insurance is paying for it.” This can sometimes increase treatment acceptance, even if reimbursements are lower.

3. More Predictable Cash Flow

With high patient volume and decent systems, you can maintain relatively steady collections—although that stability often comes at a cost.

The Cons of Participating With PPOs

While PPOs may seem like the fast track to a full practice, the hidden costs can be devastating if you don’t go in with eyes wide open.

1. Massive Write-Offs

Most PPOs require you to accept 30–60% lower fees than your standard office fees. Over a year, this can amount to hundreds of thousands in lost revenue.

2. Loss of Autonomy

Insurance companies often dictate what’s covered, what’s denied, and how you’re allowed to treat your patients. You may find yourself practicing "insurance-driven dentistry" instead of evidence-based care.

3. Administrative Overload

Insurance brings pre-auths, denied claims, appeals, verifications, EOBs, and staff headaches. You’re not just a dentist—you’re now running a billing department.

4. Limited Ability to Raise Fees

Even as costs for labor, labs, materials, and rent go up, your ability to raise PPO fees is essentially nonexistent—unless you negotiate (which many dentists never do).

5. Trapped in Discounted Care

Once you’re in-network, it’s hard to get out. Patients associate you with their plan. If you ever want to drop it, it takes strategy, scripting, and strong marketing to keep those patients.

What Should You Consider Before Signing a PPO Contract?

Before you say “yes” to PPO participation, ask yourself:

• What is the actual fee schedule? (Request and review it line by line.)

• What adjustments am I agreeing to take?

• How does this plan compare to others I’m already contracted with?

• Is this plan leased through an umbrella network I’ve already joined?

• Will this contract undercut other plans I’ve negotiated?

• Do I have the capacity and staffing to handle the increased administrative load?

• What is my break-even point per patient on this plan?

• What happens if I want to exit this plan in the future?

Far too many dentists jump into PPO participation without understanding these implications—then feel stuck and underpaid years later.

Alternatives to Joining PPOs

If you want to grow your practice without slashing your fees, you absolutely can. But it takes strategy, marketing, and intentional systems. Here are some powerful options:

1. Invest in Aggressive SEO and Digital Marketing

Most patients today don’t flip through their insurance directory—they Google "dentist near me." If your practice is optimized to show up on Google, social media, and review platforms, you can attract high-quality, out-of-network patients.

Our top recommendation for dental SEO and marketing is www.ekwa.com. They specialize in helping dental practices:

• Dominate local search rankings

• Improve reputation and reviews

• Build social media visibility

• Generate leads through paid and organic traffic

When you’re visible, patients will find you—insurance or not.

2. Launch an In-House Membership Plan

Patients without insurance still need care—but many won’t move forward without something that feels like coverage.

That’s where in-house membership plans shine. They offer patients:

• Predictable, affordable payments

• Discounts on preventive and major care

• A sense of “belonging” to your practice

And for your practice, they offer:

• Recurring revenue

• Increased case acceptance

• Long-term patient loyalty

We recommend www.BoomCloudApps.com as a trusted platform to launch and manage your membership plan with ease.

3. Train Your Team on Value-Based Communication

Whether you’re in-network or not, how your team answers the phone and explains treatment plans makes all the difference.

Patients will say yes to out-of-network care when they feel:

• Heard

• Understood

• Valued

• Confident in your expertise

Invest in training your front office and clinical team to communicate the value of your care—not just the cost.

Final Thought: Insurance Participation Isn’t a Shortcut—It’s a Strategy

Joining PPOs is a business decision, not a moral one. For some practices, it’s the right move. For others, it’s a trap disguised as opportunity.

But one thing is clear: if you do participate, negotiate your fees first.

If you’re already in-network and haven’t reviewed your contracts in years, now is the time to change that.
Contact Veritas Dental Resources to:

• Negotiate better reimbursements

• Clean up overlapping networks

• Drop unprofitable plans strategically

And if you decide to grow outside of insurance networks—know that it’s 100% possible with the right digital strategy and patient systems.

Choose your path intentionally. Your future self will thank you.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com