If you're feeling frustrated by low insurance reimbursements dictating your fees and limiting your ability to provide high-quality care, you're not alone. Many dentists reach a crossroads where they must decide whether to drop insurance contracts or negotiate better reimbursement rates. The right decision depends on your financial situation, patient demographics, and long-term practice goals. Let’s explore the best approach.

Step 1: Assess Your Current Insurance Contracts

Before making any decisions, analyze your current PPO contracts and their impact on your practice:

• Which insurance plans are the most and least profitable? Identify reimbursement rates for key procedures and compare them to your overhead costs.

• How much of your patient base relies on these plans? Dropping a plan could mean losing a portion of your patients.

• Are you running at full capacity? If you're overbooked and struggling to stay profitable, dropping low-paying plans might free up space for higher-paying patients.

Step 2: Negotiating PPO Reimbursement Rates

If dropping insurance seems risky, negotiating your fees may be a worthwhile first step. Many dentists don’t realize that some insurance companies are willing to negotiate. Here’s how to approach it:

How to Negotiate PPO Fees Successfully

1. Gather Data on Your Production – Identify the most common procedures you perform and their current PPO reimbursements. Compare these to your overhead costs and private fees.

2. Contact the Insurance Provider – Ask to speak with the provider relations department and request a fee schedule review.

3. Leverage Competing Offers – Some insurance companies will match or beat offers from competing networks to keep you in their system.

4. Consider Using a PPO Negotiation Service – If negotiations feel overwhelming, there are companies that specialize in improving PPO reimbursement rates for dentists.

5. Be Ready to Walk Away – Some PPOs won’t negotiate, so if they refuse, you may need to consider transitioning out.

Step 3: Consider Phasing Out Low-Paying PPOs

If negotiations don’t yield acceptable results, you may need to drop the lowest-reimbursing plans. However, dropping insurance requires a strategic approach to minimize patient loss.

How to Transition Away from PPOs Successfully

1. Drop the Worst PPOs First – Start with the plans that reimburse the least while keeping higher-paying ones temporarily.

2. Educate Your Patients – Clearly explain the value of your care and offer alternatives such as in-house membership plans.

3. Improve Case Acceptance – Train your team on effectively presenting treatment plans to help patients understand the importance of investing in their dental health.

4. Strengthen Your Marketing Efforts – If you're leaving PPOs, invest in marketing to attract fee-for-service patients and referrals.

5. Monitor Patient Retention – Keep an eye on how many patients stay after leaving a PPO. Often, patients who value your care will remain with your practice.

Final Thoughts: The Best Path for Your Practice

If you're struggling with low reimbursement rates, negotiating should be your first step. However, if insurance companies refuse to budge and your ability to provide quality care is suffering, phasing out low-paying PPOs may be the best long-term strategy. A balanced approach—keeping some PPOs while strategically dropping others—can help you transition toward financial freedom while retaining as many patients as possible.

Would you like help crafting a patient communication strategy if you decide to go out of network? Let me know how I can assist!