How to Move Away from PPO and Go Fee for Service
Most dental practices are running as fast as they can just to stay in the same place. You’re working harder, your overhead is skyrocketing, but your reimbursements are stuck in 2002. If you are struggling with low margins, learning how to move away from PPO and go fee for service is the only way to reclaim your clinical excellence and your lifestyle.
In our experience, the “PPO trap” is the #1 killer of quality care. When you’re forced to see 30 patients a day just to pay the light bill, quality suffers. If you’ve been wondering how to move away from PPO and go fee for service, you aren’t just looking for more money—you’re looking for your freedom back. 🗽
Typically, dentists are terrified that if they drop Delta or BlueCross, their chairs will go cold. But what if I told you that insurance dependency is actually a choice? It’s a bad one, like wearing socks with sandals, but a choice nonetheless.
The Million-Dollar Questions
- Are you tired of insurance adjusters dictating the quality of care your patients receive?
- Does it make you sick to look at your “adjustments” column and see 40% of your production vanishing into thin air? 💸
- Do you feel like a “preferred provider” is just a fancy term for “discounted laborer”?
If you’re asking these questions, you’re ready for the epiphany. The real problem isn’t the insurance companies; they are doing exactly what they are designed to do. The problem is your lack of a “Safety Net” to catch the patients who want to stay with you but lose their “benefits.”
The Step-by-Step Guide on How to Move Away from PPO and Go Fee for Service
A common mistake is thinking you can just “rip the band-aid off” and send a mass email saying “Bye, Felicia” to your PPO contracts. In most practices we see, that leads to a temporary heart attack for your front desk. You need a bridge. That bridge is a dental membership plan. 🌉
In our experience, patients don’t actually love their insurance. They love their benefits. When you provide a lateral move—a way for them to pay you directly for better service—the “loyalty” they had to the PPO vanishes instantly. This is how you drop PPO safely.
Think about it. If you have 1,000 Delta Dental patients, you aren’t actually in network with Delta; you’re in a hostage situation. Understanding how to move away from PPO and go fee for service isn’t about charging more; it’s about getting paid 100% of what you are worth.
The Story of the “Chained Dentist” and the $8 Difference
I remember talking to a doc named Dr. Dan on The Automatic Patient Podcast. He was practicing in a high-overhead area in Idaho. He was working his guts out, herding cattle through the ops, and seeing his profit margins get squeezed by inflation and stagnant reimbursements.
He realized that on some procedures, he was writing off nearly 60%. He wasn’t just a dentist; he was a silent partner in the insurance company’s profit margin. He decided enough was enough. He didn’t just drop the PPOs; he built a parachute first using BoomCloud™. 🪂
The epiphany? When he finally went out-of-network, he found that many patients only had to pay an extra $8 or $15 out-of-pocket for their hygiene visits compared to their “in-network” copay. Most patients didn’t care about the $8; they cared about Dr. Dan. But without a membership plan to bridge the gap for the “uninsured,” he never would have had the courage to jump.
Operator Insight: Why Most Practices Fail at Dropping PPOs
The real problem isn’t the patients—it’s the staff and the doctor’s mindset. If your front desk team is terrified of the “money conversation,” they will accidentally talk patients into leaving. “Oh, we aren’t in network anymore, you might want to find another office.” 🤦♂️
Common Mistakes We See:
- The Apology Tour: Dentists send letters apologizing for going out of network. Stop. You are improving your office; don’t apologize for clinical excellence.
- No Alternative: Dropping a PPO without having cash pay dental practice software like BoomCloud™ is like jumping out of a plane and then trying to sew a parachute on the way down.
- Focusing on Patient Count vs. Patient Value: A dentist wants to earn more per patient, not just see more bodies. I’d rather see 8 patients at 100% reimbursement than 16 patients at 50%.
The Financial Impact: Membership Patients are the Real Cash Cows
Data doesn’t lie. In our experience, membership patients spend 2X to 4X more on elective and restorative treatment than insurance patients. This is a critical component of how to move away from PPO and go fee for service effectively. Why? Because they don’t have a “maximum” hanging over their head like a guillotine. ✂️
When a dentist wants recurring revenue, they are looking for stability. This is where MRR (Monthly Recurring Revenue) and ARR (Annual Recurring Revenue) change the game. Imagine starting every month with $20,000 already in the bank before you even pick up a handpiece. That’s the power of the subscription model.
Case Study: Scaling to Freedom with BoomCloud™
| Metric | Results |
|---|---|
| Practice Type | General Dentistry (3 Ops) |
| Member Count | 485 Active Members |
| Monthly Recurring Revenue (MRR) | $16,975/mo |
| Annual Recurring Revenue (ARR) | $203,700/yr |
| Time to Achieve | 14 Months |
This practice replaced their lowest-paying PPO with this revenue. They reduced patient volume by 15% but increased net profit by 22%. They stopped being busy and started being productive. 🚀
How a Membership Program Increases Loyalty
The “Amazon Prime” effect is real in dentistry. When a patient pays you a subscription fee, they have “skin in the game.” They aren’t going to the guy down the street for a $19 cleaning because they already “own” their preventive care in your office.
According to ADA Health Policy Institute data, the biggest barrier to dental care is cost and lack of insurance. By creating your own plan, you remove the middleman and help patients get the treatment they actually need without waiting for a “predetermination.” 🛑
How to Optimize Revenue Per Patient
The best way to grow a practice isn’t “more new patients.” It’s optimizing revenue per patient. If you are fee-for-service, your revenue per patient naturally increases because you aren’t giving away 40% of your fee to a billion-dollar insurance company in Omaha.
Software alone doesn’t solve this. You need a shift in culture. You need a system that automates the billing, tracks the MRR and ARR, and makes it simple for your team to sign people up. That is why BoomCloud™ exists.
From Experience: The Lateral Move Strategy
In most practices we see, the “lateral move” works like this:
- Identify your PPO patients with high copays or maxed-out benefits.
- Show them the math: “Mr. Jones, your insurance costs you $50/mo and has a $1,500 max. Our plan is $35/mo, has no max, and gives you 20% off that crown.”
- Watch them choose you over the insurance company every single time. 🎯
Financial Breakdown: Simple Math for FFS Transition
Let’s do some quick back-of-the-napkin math to illustrate how to move away from PPO and go fee for service without losing your shirt. 📝
If you produce $1,000,000 a year but write off 40% for PPOs, you collect $600,000. Your overhead (let’s say 60% of production) is $600,000. Congratulations, you just worked an entire year for zero profit. That is the PPO cycle of death.
Now, let’s say you go Fee-For-Service. Your production drops to $800,000 because you lose some “PPO shoppers.” But your collection rate is now 98%. You collect $784,000. Your overhead drops because you need less staff to fight insurance companies. You now have a healthy profit with less work.
FAQs About Dropping PPOs and Going Fee For Service
How do I drop PPO safely without losing my patient base?
The secret to how to move away from PPO and go fee for service is creating a “Safety Net” membership plan before you drop the contract. Offer patients a way to stay with your practice for a similar monthly cost but with better benefits. Communication is key—focus on clinical quality, not the “legalities” of the insurance contract. A solid plan can even help with patient retention problems.
I am a dentist who wants to earn more per patient—is FFS the only way?
It’s the most direct way. When you move to FFS, you eliminate the “discount” you provide insurance companies. Pairing this with a membership plan ensures high-value patients stay and spend 2X–4X more on restorative work because they trust your plan over a PPO. This also helps improve your case acceptance rate.
What is the best cash pay dental practice software?
For managing recurring revenue, MRR, and automated memberships, BoomCloud™ is the industry standard. It integrates with your workflow to turn “one-time” patients into “lifetime” subscribers, providing the predictable cash flow you need to ditch PPOs for good. 💎
The Final Word: Software Alone Isn’t the Answer
You can buy the best software in the world, but if you don’t have the “courage of your convictions,” it won’t matter. You have to believe that the care you provide is worth the fee you set. Insurance companies have spent decades convincing you that your work is a “commodity.” It’s not. It’s healthcare.
If you’re ready to stop being a “provider” and start being a “doctor” again, it’s time to switch. Build your plan, train your team, and take back your practice’s economy by mastering how to move away from PPO and go fee for service. 🏛️
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