Plan Foward Pricing: How to Stop Chasing PPO Crumbs and Build Real Wealth
Let’s be honest: are you running a dental practice or an insurance-subsidized nonprofit? 🤨 If you’re staring at your EOBs and seeing 40% of your production vanish into “contractual write-offs,” you’ve got a leak in your boat.
Most dentists spend their lives as “middlemen” for Delta Dental. You buy the equipment, pay the staff, and do the surgery. Then, you let a cubicle-dweller in another state decide what your hands are worth.
Is that really why you went to dental school? To beg for 2002-level reimbursements while your overhead climbs like a SpaceX rocket? 🚀
It’s time to talk about plan foward pricing. No, not the stagnant “discount” model that most offices slap together. I’m talking about a subscription-driven revenue engine that makes insurance companies irrelevant.
The PPO Punch in the Face: Why Your Current Model is Dying
I recently chatted with Dr. Dan Nelson on the Automatic Patient Podcast. Dan was tired. He was “herding cattle” through his practice just to keep the lights on. He realized that the more PPO patients he saw, the less money he kept.
Insurance isn’t a “benefit” for you; it’s a tax on your expertise. When you rely solely on PPOs, you lose the ability to control your own pricing strategies. You’re trading your time for a fraction of its value. This is a common issue that leads to patient retention problems if not addressed.
Ask yourself these three questions:
- Does it make sense to give away 40% of your fee to someone who doesn’t help you treat the patient?
- Why do your “uninsured” patients feel like a burden instead of your biggest growth opportunity?
- How much Monthly Recurring Revenue (MRR) are you leaving on the table by not offering a direct-pay option?
If those questions make your stomach churn, good. That’s the first step to freedom. 🗽
The Epiphany: Subscription Patients Are Worth 2X-4X More
Here is the “dirty little secret” the insurance companies don’t want you to know: Patients with a membership plan spend two to four times more than those who pay out of pocket or rely on limited insurance benefits.
Why? Because of the “Amazon Prime Effect.” When a patient pays you a monthly subscription, they feel like they own a piece of the practice. They aren’t “going to the dentist”; they are “using their membership.”
This shift in psychology leads to massive Annual Recurring Revenue (ARR). You stop being a “one-off” transaction and start being a monthly necessity. That is how you stabilize your cash flow and retire the “feast or famine” cycle forever.
Case Study: High-Growth Family Dental Scaling to Six Figures
Meet “Summit Dental.” Two years ago, they were 90% PPO dependent. They were busy, but they weren’t profitable. They implemented plan foward pricing for dental offices using BoomCloud™ to manage the backend. They focused on their “wrong avatar” patients—those who were dropping insurance—and moved them laterally into a membership.
| Metric | Before BoomCloud™ | After 18 Months |
|---|---|---|
| Active Members | 0 | 412 |
| Monthly Recurring Revenue (MRR) | $0 | $14,420 |
| Annual Recurring Revenue (ARR) | $0 | $173,040 |
| Acceptance Rate for Major Work | 31% | 68% |
Summit Dental didn’t just add $173k in “free” money. They added high-loyalty patients who refer their friends and never complain about “what insurance covers.” That is the power of a subscription dental revenue software strategy. 📈
Plan Foward Pricing Strategies: How to Set the Right Rate
One mistake I see constantly is offices pricing their plans too low. They think they are competing with a Groupon. You aren’t! You are offering direct pay dental RCM that provides concierge-level access to the best doctor in town (you).
Your dental membership pricing strategies should be based on three things:
- Valuation of Hygiene: Total up your prophys, exams, and x-rays. Divide by 12. Add a 10% convenience fee.
- The Loyalty Factor: Include a flat 15-20% discount on all other procedures. This keeps them in your chair for the big stuff, improving your case acceptance rate.
- The Profit Buffer: Ensure your MRR covers your basic hygiene overhead so every crown is “gravy.”
Using a dental revenue cycle platform like BoomCloud™ allows you to automate the billing, so you don’t have to hire a new person to manage the “plan foward” books. This is about working smarter, not harder.
Why Loyalty is the Real Currency in Dentistry
A patient who is “in-network” is only loyal to the network. If their employer switches to Cigna tomorrow, they are gone. Poof. 👋
But a membership patient? They are loyal to you. By taking the insurance middleman out of the relationship, you create a direct bond. This increases treatment acceptance because the patient trusts your diagnosis—not a 1-800 number’s approval.
Optimizing revenue per patient is the fastest way to grow. You don’t need 500 new “PPO shoppers” a month. You need 500 loyal members who spend 3X more. That is the math of a million-dollar practice. 💰
Mistakes to Avoid with Your Direct Pay Model
Don’t try to manage this on a spreadsheet. I’ve seen it, and it’s a disaster. It’s like trying to run an airline with a legal pad. You need a dedicated dental membership revenue software to handle credit card expirations, automated renewals, and member tracking. This is crucial for avoiding cancellations.
Also, don’t keep your plan a secret! Your team needs to be “Ownership Junkies.” Every patient without insurance should be greeted with: “Did you know we have a private membership plan that’s better than most insurance?” 🗣️
Frequently Asked Questions (FAQs)
Does BoomCloud™ count as dental revenue management software?
Absolutely. BoomCloud™ is more than just a billing tool; it’s a comprehensive platform that manages your MRR, patient compliance, and growth metrics. It integrates with your flow to provide a seamless subscription dental revenue software experience.
How does plan foward pricing for dental offices affect treatment acceptance?
When patients have a “membership,” the mental barrier to spending money on their health drops. They are already invested. Data shows that members accept treatment 50-70% more often than non-members because the “plan” makes it affordable without the insurance headache.
Can a dental membership pricing strategy replace PPOs entirely?
Yes. Many of our most successful doctors have gone “Fee-For-Service” by using BoomCloud™ as their “parachute.” They drop the low-paying PPOs, move the patients to their own membership plan, and regain their time and profitability. It’s a direct pay dental RCM revolution.
The Final Verdict: Is Your Practice Future-Proof?
Insurance companies are getting smarter. They are using AI to deny claims. They are buying up practices. They are moving to own the whole “multi-sided market” (see the Automatic Patient Podcast for more on this evil empire). 🧛♂️
If you don’t own the patient relationship through a subscription model, you don’t own your business. You’re just a tenant in Delta Dental’s building. This kind of thinking can impact overall DSO growth if not addressed by individual practices.
It’s time to take control. Use plan foward pricing. Build your ARR. Treat your patients like members, and they will treat you like a premier doctor. Let’s get to work.
🚀 Ready to transform your practice?
- Download the million-dollar membership plan ebook 📖
- Take The Six-Figure Patient Membership Plan Course 🎓
- Schedule a Demo of BoomCloud™ & Learn how to manage & grow your membership plan 🖥️
- Create Your BoomCloud™ Account ✅
