Fire Your Worst PPO Plan (Not All of Them)
Most dentists have never ranked the PPO plans they accept — they just stay in-network with everyone because dropping any of them feels risky. That habit hides the practice's single biggest expense: the contractual write-off, the gap between your full fee and what a plan actually pays. It gets netted out before revenue is ever booked, so it never shows up as a line on your P&L. At least one plan you're keeping is almost certainly doing you real harm — paying you deep below your fee while sending you almost no patients — and you'd never spot it without doing the math plan by plan.
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The Problem
Most dentists have never ranked the PPO plans they accept — they just stay in-network with everyone because dropping any of them feels risky. That habit hides the practice's single biggest expense: the contractual write-off, the gap between your full fee and what a plan actually pays. It gets netted out before revenue is ever booked, so it never shows up as a line on your P&L. At least one plan you're keeping is almost certainly doing you real harm — paying you deep below your fee while sending you almost no patients — and you'd never spot it without doing the math plan by plan.
The Playbook
You don't need to go fee-for-service and you don't need to drop your whole panel. Treat your accepted plans as a portfolio, not a blob, and score each one on two numbers: Pull a production-and-write-off-by-plan report from your practice-management software — most systems already have it, you likely just haven't run it. Rank every plan on two columns: effective reimbursement against your full fee, and patient volume — how many patients that plan actually sends you each month. Find the plan at the bottom of both columns. Deep discount, thin flow — that's your fire-or-renegotiate candidate, not the whole book. Run the honest what-if before you act: how much write-off you'd win back, and how much volume you'd actually risk, if you dropped that one plan. Choose a tool, not a leap: renegotiate the fee schedule directly (or through a third-party/leased-network arrangement), or drop the plan outright — a scalpel, not a sledgehammer. Confirm contract-notice terms and plan the patient message with your own advisors before you act.
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Sources & Data
- ADA Health Policy Institute — PPO participation & reimbursement trends.
- General practice-management method — fee-schedule audit and plan-portfolio ranking.
- Accounting framing — contractual write-offs netted before net-revenue recognition.