How to Play Offense and Defense in Today’s PPO Environment

Many dental practices are taking a hard look at their PPO participation—and for good reason.

With rising overhead, stagnant reimbursements, and increasing plan restrictions, staying in-network with every PPO often becomes financially and clinically unsustainable. As a result, more dentists are choosing to go out of network with low-paying plans. But here’s the real question:

Should you be negotiating with some PPOs while dropping others at the same time?

The answer: Yes—if done strategically.
In fact, this dual approach can help you protect your revenue, optimize your patient base, and regain control over how you practice dentistry.

Let’s break down the strategy, risks, and best practices.

The Strategy: Play Offense and Defense

Dropping a PPO is a defensive move—you’re protecting your practice from low reimbursements and restrictive terms.

Negotiating with another PPO is an offensive move—you’re strengthening your profitability with the plans you choose to keep.

Doing both simultaneously allows you to:

• Eliminate the worst contracts that hurt your margins the most

• Improve revenue from the plans you decide to keep

• Maintain patient flow by making other plans more financially viable

• Create leverage in negotiations by showing you’re willing to walk away

Risks to Consider

While this strategy can be powerful, it’s not without risk. Here are some pitfalls to avoid:

Lack of Plan Awareness

Some PPOs are linked through leased networks or shared agreements. Dropping one plan or negotiating another could impact multiple PPOs—without you realizing it.

Solution: Request a complete list of network affiliations before making any moves. Know who you're really contracted with.

Poor Communication

If you drop a PPO without properly notifying patients—or without preparing your team—you risk losing loyal patients who think their insurance is no longer accepted.

Solution: Communicate clearly and early. Emphasize that patients can still use their benefits out of network, and you’ll help them get the most out of their plan.

Negotiating Too Late

Some PPOs only allow fee schedule negotiations once per year, and they move slowly (30–120 days). If you're not proactive, you might miss the window to renegotiate before making big changes.

Solution: Time your renegotiations to align with your exit strategy. Start the process early—well before dropping any plans.

Best Practices for Doing Both Successfully

1. Rank Your PPOs

Create a scorecard for all PPOs based on:

• Reimbursement rates

• Volume of patients

• Administrative burden

• Restrictions on care

Drop the worst performers, and negotiate with the ones worth keeping.

2. Negotiate with Data

When requesting higher fees, show:

• Your current UCR (usual, customary, and reasonable) fees

• Production and claim volume for key codes

• Regional benchmarks or inflation-adjusted rates

• The fact that you’re reassessing participation

Hint: Mention that you're exiting low-fee plans because it's no longer viable—this signals that you're serious about the value of your time and care.

3. Leverage the Shift

When you drop low-paying PPOs, your schedule opens up. That’s your opportunity to:

• Attract more patients from better-paying plans,

• Offer in-house membership plans,

• Focus more on fee-for-service or high-value treatment.

4. Train Your Team

Your front desk and treatment coordinators need to:

• Explain what “out of network” really means (hint: it doesn't mean no coverage),

• Present financial options with confidence,

• Reassure patients they’ll still get help with claims and maximizing benefits.

Example in Action

A practice in Georgia recently dropped two low-fee PPOs that reimbursed under $700 for crowns. Simultaneously, they negotiated a 12–18% fee increase with their top three PPOs.

The result?

• 20% of their patient base went out of network—but 90% stayed.

• Monthly production increased by over $20,000.

• The team had fewer restrictions and more time for quality care.

Why did it work? Because they didn’t just drop—they negotiated strategically.

Final Thoughts: Take Control of Your PPO Strategy

You don’t have to stay trapped in the PPO maze. You can drop bad contracts and strengthen good ones at the same time.

By taking a proactive approach, you protect your practice’s financial health, maintain your clinical standards, and show patients that your loyalty is to their care—not to an insurance company.

Need help analyzing your PPO contracts, drafting a negotiation letter, or creating a patient communication plan? I can help—just let me know!

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