How to Drop PPOs Without Losing Patients (And Still Make a Profit)

Q: I’m in network with a lot of reduced fee plans, and it seems like no matter how hard I work, I’m still barely able to cover my overhead. How can I drop some of these plans without losing all my patients?

A: I talk to dentists all across the U.S. that are facing the same frustrating reality: you’re in network with multiple insurance plans, you’re working full throttle, producing more, seeing more patients, and yet there’s barely enough left over to cover your overhead.

So what gives? And more importantly, how do you fix it—without losing your patient base?

Let’s break it down.

Why You Can’t Get Ahead on PPOs

The math just doesn’t work anymore. 

Most PPOs involve a 30–50% write-off. Combine that with rising costs—post-pandemic spikes in staffing, lab fees, and supplies—and you’re underwater before you even get started.

Thirty years ago, it was widely accepted that a dentist’s overhead should hover around 50%. Fast forward to today, and it’s not uncommon to see overheads at 80–100%, especially when you include doctor compensation. In other words, there’s nothing left.

Why? PPO fees haven’t kept pace. In some cases, they’ve actually dropped since the pandemic. And as costs go up, reimbursements stay flat—or fall.

Unless you’re doing large cases ($10K, $20K, even $30K), and operating more independently of insurance, you’re stuck in a system that actively works against your profitability.

“But If I Drop PPOs, Won’t I Lose My Patients?”

This is the #1 fear that keeps dentists trapped in PPO plans. But here’s the truth:

Even when dentists drop PPOs the wrong way, they rarely lose more than 30% of their patients.
And when it’s done right, patient attrition can be close to zero.

Insurance companies have invested millions into marketing this idea that if you leave their plan, you’ll lose everyone. It’s just not true.

Yes, dropping PPOs requires strategy. But it’s not the apocalyptic event some make it out to be.

Why Patients Really Leave

Most patients don’t leave because your crowns now cost more. The real reason?

Preventative services now have a copay. 

That’s it.

Patients are creatures of habit. They’re used to their cleanings being “free.” So when they suddenly get charged $10, $20, or more out-of-pocket for a hygiene visit, it feels like a betrayal—even though the same patients wouldn’t blink at a crown copay.

And legally, you can’t just waive that copay—it would be insurance fraud. So how do you navigate this without creating backlash?

The 3 Insurance Fees You Need to Understand

Here’s the key to structuring this transition:

1. Private Fee – This is your fee-for-service price (e.g., $1,500 for a crown, $150 for a cleaning). It’s what you believe your services are worth.
2. Negotiated Fee – The reduced rate you’ve agreed to with the insurance company (e.g., $800 for a crown, $50 for a cleaning).
3. Allowable Fee (UCR) – The “maximum” the insurance will pay when you’re out-of-network. Often lower than your private fee, but higher than the negotiated fee.

When you drop a plan, the insurance still pays a percentage of the allowable fee—but not your full private fee.

How to Drop PPOs (and Keep Your Patients)

Dropping PPOs isn’t just about cutting ties—it’s a business strategy that requires preparation, communication, and staff coordination.

Here’s how to do it without losing your patient base:

1. Start with One Plan

Don’t try to drop everything at once. Choose your worst-performing PPO—the one with the lowest reimbursements or steepest write-offs—and start there.

This allows your team to adjust and gives you time to fill any gaps before moving on to other plans.

2. Adjust Fees Strategically

Structure your fees to reduce patient pushback:

• Keep preventive service fees (cleanings, exams, x-rays) at or near the insurance’s allowable fee
  → This avoids copays for hygiene, which is where most patient objections happen.
• Charge your private fee for major and basic procedures (crowns, fillings, implants, etc.)
  → Patients expect out-of-pocket costs for these and are less likely to leave because of them.

This approach keeps the “covered services” feeling intact—while improving your profitability.

3. Communicate Before the Insurance Company Does

Don’t let the insurance company control the narrative. Proactively notify patients via:

• Email or letter from the doctor
• Front desk conversations during scheduling
• Signage and verbal reminders in-office

Emphasize that:

• You’ll still help with claims and reimbursement
• You’re not abandoning their insurance, just changing how it’s handled
• This shift allows you to provide better care without restrictions

4. Train Your Team

Your staff must know how to talk about this—confidently and positively. Avoid phrases like, “We don’t take your insurance anymore.”

Instead, say things like:

“You can absolutely still come to us—we’ll help you use your benefits and walk you through any changes.”

Pair that with solid financial presentation skills, and patients will stay.

5. Tighten Up Your Financial Systems

Set clear financial expectations:

• Collect estimated patient portions up front
• Offer financing for larger cases
• Submit claims on the patient’s behalf
• Ensure patients know how and when they’ll be reimbursed

Make the process smooth and predictable. The easier you make it, the more likely patients are to stay.

6. Reactivate First

Before dropping a plan, reactivate overdue and inactive patients. This fills your schedule and cushions any attrition.

Bonus: many of these patients are overdue because they weren’t happy with their insurance-driven care to begin with—they’ll welcome the upgrade.

7. Rinse and Repeat

Once you’ve dropped one PPO successfully, analyze the results:

• Patient retention
• Collections per visit
• Overall profitability

Then use that experience to drop the next plan with more confidence and control.

Final Thoughts (and a Word of Caution)

Yes, you can drop PPOs successfully. But it has to be done strategically:

• Train your team to avoid phrases like, “We don’t take your insurance anymore.”
• Don’t go cold turkey without prepping your patient base.
• Do your reactivation and case presentation groundwork.

And most importantly, don’t go it alone.

Want Help Making the Switch?

If you’re considering dropping PPOs—or already tried and hit roadblocks—we can help you build a customized transition plan. We’ve helped thousands of dentists escape the insurance trap without losing their practice (or their minds).

Call us at (800) 640-1140 or visit www.mgeonline.com to schedule a free consultation.