166: Dropping PPOs: The PPO Squeeze

Participants:

Wes Read, host, PracticeCFOMegan Shelton, a practice management consultant specializing in dentistry who previously owned and sold her own dental practiceMichael Anderson, a dental marketing consultant with 13 years in the industry

Duration: 60 minutes

Reimbursement is flat while overhead climbs, and most owners have at least daydreamed about dropping Delta. This session breaks the decision into three levers, price, friction, and yield, and argues that the fee schedule is rarely the real problem. Friction, the cost of collecting the money, is what owners actually control.

Key topics

UCR fee schedules and percentile benchmarkingClaim denials, eligibility, and breakdownsPer-plan profitability mathMarketing readiness before going out of network

Key takeaways

The squeeze is often the cost to collect, not the fee schedule.An 80 percent PPO practice can still be highly profitable.Not every plan delivers the same patient; case acceptance varies by carrier.A practice with no marketing history will struggle to go fee for service.

Actions to consider

Run a UCR percentile analysis and raise fees toward the 80th to 85th percentile, then resubmit.Pull payer distribution and case acceptance by plan to find your worst performer.Verify eligibility within two days of every visit and get a full breakdown, not a coverage table.