166: Dropping PPOs: The PPO Squeeze
from The Dental Boardroom
Participants: Wes Read, host, PracticeCFO Megan Shelton, a practice management consultant specializing in dentistry who previously owned and sold her own dental practice Michael Anderson, a dental marketing consultant with 13 years in the industry Duration: 60 minutes Reimbursement is flat while overhead climbs, and most owners have at least daydreamed about dropping Delta. This session breaks the decision into three levers, price, friction, and yield, and argues that the fee schedule is rarely the real problem. Friction, the cost of collecting the money, is what owners actually control. Key topics UCR fee schedules and percentile benchmarking Claim denials, eligibility, and breakdowns Per-plan profitability math Marketing readiness before going out of network Key takeaways The squeeze is often the cost to collect, not the fee schedule. An 80 percent PPO practice can still be highly profitable. Not every plan delivers the same patient; case acceptance varies by carrier. A practice with no marketing history will struggle to go fee for service. Actions to consider Run a UCR percentile analysis and raise fees toward the 80th to 85th percentile, then resubmit. Pull payer distribution and case acceptance by plan to find your worst performer. Verify eligibility within two days of every visit and get a full breakdown, not a coverage table.
Embed this episode
No transcript yet.