Deciding Whether To Join Or Drop A PPO

Many dentists agonize over decisions regarding PPOs – specifically, whether to join or drop them. The two main reasons that most dentists decide to participate in PPOs have to do with a fear of losing patients and fear of having holes in the schedule. These are the same two reasons that dentists continue to participate in PPO networks even if it’s no longer profitable to the practice.

What to consider before joining or dropping a PPO

Below are a few things to consider before making a decision regarding a PPO:

1. Analyze the plan – The first thing to do when analyzing a PPO plan is to identify which procedures are covered and the services not covered. Make sure your office is compatible with this plan. To be fully informed, it might be a good idea to contact the PPO directly and request the most current contract, in-network fee schedule, and processing policy.
2. Calculate the net collections and average write-off for each PPO – If you’re currently participating in PPOs, add up the total amount paid by each carrier to the total amount paid by the members on the plan in order to determine the net revenue for a 12-month period. To calculate the write off, use the same 12-month period and calculate the total write-offs taken for each network. Divide this by the total revenues generated by each network.
3. Know the percentage of your patients covered – Depending on how many of your patients participate in a certain PPO, joining or dropping the PPO can have a significant impact on the success of your practice. The more patients covered by the plan, the more your decision will affect your bottom line. Calculate the amount of your established patients covered by each PPO plan before making your decision.

If you’re considering adding or dropping a PPO, we here at CTC National can help! Call and speak with a dental consultant before deciding to take the PPO plunge!