The Plus Side of PPOs

By Dr. McKinzie Jeffrey

December 13, 2022

A Year in Review

With the year coming to an end, something I have looked back on this year with excitement is a more positive view of being a PPO office.

A shocking statement, I know.

We have been heavy PPO since the start, almost 8 years ago. Over the last 5 we have slowly been changing the dynamic. This originally began when we started working with Unlock the PPO in 2018. What started out as us simply wanting them to help us negotiate higher fees turned into getting much more acquainted with the insurance world. Most of the plans that we had signed up to be providers for was simply because the owner before us did, so we did. We found ourselves working so hard to see so many patients for very little production.

It seemed impossible to meet daily goals, do good dentistry and not feel like you were running around like a chicken with your head cut off! This was not the way we wanted to treat our patients and we knew we didn’t want to continue growing a practice in that direction.

The longer we stayed in network with these low reimbursing insurances, the more and more new patients came in utilizing it and the race continued. After analyzing all of our in network plans, we started our process of dropping the lowest reimbursing 1 or 2 at a time per year. Waiting until the end of the year to drop any of them to try and retain as many patients as possible by giving them the opportunity to ask questions and potentially switch their plan to one we were remaining in network with. We only suggested they switch to one we knew at the end of this plan we would still remain in contract.


A Year Ahead

2023 we will start the year with only being in network with insurance companies that pay 80% or more of our office fee schedule. With this percentage we are able to do quality dentistry, have the time to develop relationships with our patients and meet our production goals. Of course, being in network still comes with its own set of problems. Problems that you can solve as long as you recognize them and create systems to prevent them in the future.

Wishing you the best in 2023!