Why Leaving PPOs Has Less To Do With Fees, and Everything To Do With How Your Practice Actually Runs
Written by: Kari Miller, IGP Business Advisor, Productive Dentist Academy
“I don’t think we can keep doing this.”
That’s a realization that tends to surface in the middle of your day, in between patients, charts, and after a quick glance at your numbers that just aren’t adding up. Your schedule is packed, your hygiene department is booked out entirely, and everyone on your team is moving as fast as they can to keep everything on track. You’re busier than ever, but the math isn’t mathing.
Overhead keeps taking huge bites. Your most productive team members keep asking about raises. There’s no room to breathe or even think strategically. You know your practice should be way more profitable than this. That’s typically when you ask, “What if we just dropped insurance?”
It’s a fair question. You’ve heard other practices’ “the-grass-is-greener-on-the-other-side-of-PPOs” success stories, but what often gets overlooked is what that decision actually requires.
If you walked into your practice tomorrow morning and announced to your team that you were no longer participating with insurance, what would need to change? Pricing, surely, but would it surprise you to learn that pricing is the least important change you’d need to make?
Most dental practices have been shaped over time by the systems required to support insurance. It was never your intention for your practice to be guided so much by insurance. Patient scheduling, phone conversations, treatment presentations, and even the way teams are trained to think all tend to revolve around insurance coverage, verification, and reimbursement. Those systems don’t disappear because a PPO contract does. If those systems remain unchanged, they continue to influence how your practice operates, and that’s where the problems show up.
Transitioning away from insurance is best understood as an operational shift instead of a financial one. It asks the practice to align how it communicates, how it delivers care, and how it supports patients from the first interaction all the way through treatment. Without that alignment, removing insurance introduces strain on a structure that was primarily built for insurance.
One of the earliest places this becomes apparent is in conversation.
What You Say and How You Say It Matters
When a patient calls a practice, one of the first questions they ask is about insurance. That question has been trained into the system over time, and it reflects what the practice has learned to prioritize. From the patient’s perspective, it’s also one of the only questions they know how to ask. Insurance is the language most people use to navigate care, even if they don’t fully understand it.
But underneath that question is something more fundamental. Patients are trying to figure out whether they’re in the right place. They want to know if they’ll be taken care of, if they’ll be understood, and if they can trust the people on the other end of the phone.
When the conversation begins by reinforcing why they called, using their name, and helping them feel seen, the dynamic changes. Insurance still remains part of the conversation, but it no longer defines it. Insurance becomes something the practice helps them navigate rather than the foundation of the relationship. That shift starts long before any formal change in participation.
The same idea carries into the patient experience itself.
The Patient Experience
A young lady goes to the dentist for the first time on her own, and a few days later, she receives a handwritten “thank-you” card in the mail. It’s a simple gesture, but it catches her attention. She talks about it. She tells her friends because it was such a pleasant personal touch.
Moments like this carry more weight than most practices realize. Patients might not remember your clinical recommendations, but they will always remember how you made them feel. Patients notice whether they feel rushed or welcomed, whether they had to repeat themselves, whether someone took the time to look them in the eye and acknowledge them as a person.
Little things like this shape how patients talk about your practice outside of it. They influence whether someone feels connected enough to stay, even when circumstances change, like how your practice uses insurance from now on.
In many high-volume environments, efficiency becomes the dominant priority. Patients move quickly from one step to the next, and the system is built to keep everything on schedule. When a practice begins to shift away from that model, the focus expands. The experience becomes something that can be observed, refined, and improved at each stage.
The initial phone call sets expectations. The front desk interaction reinforces them. The handoff between team members carries information forward so the patient doesn’t feel like they’re starting over. By the time the doctor enters the room, the patient already has a sense of continuity. Even a brief moment of focused attention can make a meaningful difference when the rest of the experience supports it.
As these elements begin to align, your practice starts feeling more coordinated. Patients notice the consistency and experience fewer disconnects. The visit feels smoother, even when the clinical care itself hasn’t changed.
Working concurrently with these changes is understanding the numbers behind the practice.
When practices consider stepping away from insurance, the conversation often begins with fear of losing patients, fear of an open schedule, and fear of the unknown. Those concerns are valid, but they tend to be shaped by assumptions rather than data. Once the numbers are understood (like annual patient value, case acceptance, and the impact of specific plans), the conversation becomes more grounded.
Clarity changes how decisions are made. Rather than reacting to what might happen, the practice can evaluate what is happening and plan accordingly. That shift from uncertainty to visibility is what allows strategy to take form.
But none of this works without your team.
Total Team Alignment
If your team isn’t fully aligned, it shows up immediately in how conversations are handled. Patients pick up on hesitation, uncertainty, and inconsistency. When the team understands the purpose behind the shift and feels confident in how to communicate it, those same interactions feel steady and clear.
This comes entirely from shared understanding. When the team believes in what they’re doing, patients feel it in every interaction. There’s no room for memorization of scripts here. That doesn’t work. When your team believes in these changes and understands the full picture, they can speak from the heart.
Marketing Support
There’s also a practical concern that sits underneath all of this: patient flow.
Many doctors worry about what will happen to the schedule if insurance is removed. That concern points to the role marketing plays inside the practice. Patient retention, referrals, re-engagement, and community presence all contribute to stability over time. When those elements are active and consistent, they support the practice before any major transition occurs.
Over time, the focus turns to building a practice patients choose to stay with, regardless of insurance coverage.
Which brings us back to the original question: If you dropped insurance tomorrow, what would need to change?
Your clinical philosophy would remain the same, as would your commitment to your patients. The difference would show up in the systems that support both, like how your practice communicates, how your team operates, how your patients experience care, and how your decisions are guided by data rather than assumption. Those systems are what determine whether a practice feels strained or aligned.
Most doctors can feel when something isn’t working. The pressure shows up in the day-to-day, even if it’s hard to explain exactly why.
What this really comes down to is taking a closer look at how the practice is set up to run. The conversations, experience, team, and numbers, all of it working together or working against you.
When you start to see that more clearly, different questions come up. You begin to think about what your practice is built around today and whether that still fits where you want it to go.
ABOUT THE AUTHOR
Known for her practical insight, radical empathy, and straight talk, PDA IGP Business Advisor Kari Miller helps dentists and their teams bridge the gap between struggle and success. With more than a decade of coaching experience, Kari empowers practice owners to see their potential clearly and take confident steps toward lasting growth. Her approach balances compassion with accountability, celebrating wins while tackling challenges head-on. Rooted in resilience and authentic care, Kari’s work is guided by one belief: when you trust yourself and take great care of others, great things happen.
FEATURED IMAGE CREDIT: KinoMasterskaya/Shutterstock.com.
