Q: I want to get out of the PPO plans I’m in, but I’m hesitant because I don’t know what’s going to happen with the economy. Should I wait to see how things shake out before making a decision?

A: Great question! I’ve been hearing this concern quite a bit recently.

I’m going to give you my opinion here, but keep in mind that it is just that—my opinion. I’m not an economist and I don’t have a crystal ball, so I can’t tell you what’s going to happen with the economy.

I can tell you that the way I see it, if there is another financial crisis in the future, in-network dentists are going to struggle much more than fee-for-service dentists.

We’re already seeing this effect: as inflation rose drastically over the last couple years, most insurance companies kept reimbursements stagnant or even lowered them. The most obvious thing you should do when there is inflation is raise your fees, but you can’t do that if you’re stuck in a fixed-fee insurance plan.

If you’re in-network, you’re not really in control of your own business or your future.

It’s obviously in the best interest of insurance companies to keep you in-network; after all, they can only exist if they have participating providers. And I hesitate to use the word “fear-mongering”…but ever since the inception of PPO and HMO insurances, fear has been a big motivating factor in dentists joining and staying in-network.

The fear is: “Everyone else is joining plans, so I can’t be the only one out-of-network,” or “The patients in my area will only go to in-network dentists,” or “It’s risky to practice without that reliable baseline of patients from the insurance plan.”

That’s how we wound up in the situation the industry currently finds itself in. The irony is that the fear was self-fulfilling. If nobody was scared of being left out, nobody would have joined up and the insurance companies wouldn’t have had any power.

So once again, this is just my opinion, but I see staying in-network as the riskier option.

If the economy takes a turn for the worse and it’s harder to pay for labs, supplies, lease payments, employees, etc., you don’t want to be stuck in fixed-fee schedules or be in a position where insurance coverage is practically dictating what treatment you are performing. That sounds miserable.

Going forward, I see the only way to be able to do the dentistry you feel is right for the patient and be reimbursed properly for it—is to be capable of existing out-of-network.

So, I say start laying the groundwork early. Start transitioning out of insurance plans now so you know you are capable of operating independently and practicing the way you want to practice dentistry.

It takes time to do this. To make such a major pivot in your business, you have to make sure you plan it out well. We have lots of articles, videos, podcasts, free webinars, etc., on this topic, but we also offer free consultations for it because how you should go about it is highly individualized. There is no one-size-fits-all approach to this—but it is possible for anyone to go out-of-network successfully as long as they have the right approach.

And in a worst-case scenario, it’s much easier and quicker to sign back up for an insurance plan than it is to transition out of them. So do the transition now.

Schedule a free Fees & Plans Analysis with us here and we’ll analyze all the numbers with you and create a unique plan that will work for you.

We’ve helped thousands of clients do it already with vastly improved productivity and profitability, so we can definitely help you do it, too.

It takes some courage to do this. But, it also took courage for you to open your own dental practice instead of being an associate doctor. Since you have all the stress of being a business owner, you might as well enjoy the benefits and freedoms of private ownership—and you can only truly do that if you control your business, not the insurance companies.

And if you need help with anything at all, you can always schedule a free consultation with us here.

Good luck!


No Comments

Be the first to start a conversation

Leave a Reply

  • (will not be published)