The steps needed to drop a PPO contract are generally straightforward; building a practice that can sustain and thrive in an environment without PPO dependency takes more preparation.

The decision to drop one or more PPO contracts is often made from frustration due to low reimbursement, claim denials, and the endless processing of paperwork and verification of benefits. These are all valid reasons to consider severing ties with PPO-contracted carriers. However, before making this crucial decision, check the building blocks of the practice — is the foundation of your practice strong enough to sustain the change?

1. Your philosophy of care and diagnostic style must be able to withstand the potential loss of patients.

If you are highly conservative in your treatment planning, you need more patients to keep your schedule full. If you tend to be proactive in your diagnosis, even creating 5-year oral health plans for your patients, you need fewer patients to keep your schedule full. Reflecting on your diagnostic style is an important step in determining if you can successfully go out of network.

2. Know your annual patient value.

The national average annual patient value is $785. You can quickly calculate your annual patient value by dividing your annual production by the number of active patients in the practice. Active patients are defined as patients with billable treatment within the last 12 months.

3. Study your case acceptance rate.

While your diagnosis gets the ball rolling, other systems must be in place for treatment to take place. Review language skills and how to successfully transition the patient from the clinic to an administrative team member to schedule the next step and gain financial acceptance. Your team should use open-ended questions to engage the patient more fully in dialogue. Sincere communication has more power than scripting; your patients can sense the difference and want to feel cared for. PST can provide additional case acceptance resources and talking points for staff meetings.

4. Include the patient experience regularly at staff meetings for continual focus and improvement.

The experience the patient receives must match additional fees they may encounter when you move out of an in-network status. Their experience is only as good as the last encounter; make each one memorable.

5. Your physical space needs to reflect a higher patient experience as well.

Update the décor if needed and offer patient comfort items.

6. Increase your marketing efforts to target fees for service and out-of-network patients.

A strong marketing presence is needed to combat the potential loss of patients.

7. Offer an in-house membership plan.

Offering an in-house membership plan can help close the gap for patients that want to stay in your practice but don’t have access to traditional dental insurance benefits through an employer.

8. Prepare your team for the transition.

Prepare your team with frequent, open communication that focuses on the patient experience as well as language skills for enhancing case acceptance.

9. Create a 6-month drop plan that will allow time to personally communicate the change in network status from “in-network” to a “non-restricted” provider with your patients.

Be prepared to calm their fears by letting them know you will continue to maintain a close network relationship with their insurance provider, you will continue to file claims on their behalf, help them understand their benefits, and provide an estimate prior to treatment to avoid any surprise bills. Let them know that you have many patients on the same plan and are looking forward to caring for their smiles for years to come. This helps create a sense of belonging as the patient realizes many others in their situation are continuing their care at the practice.

Category: Practice Consulting