I was asked to write an article on how to be profitable with PPO Plans, because that is our specialty here at My Practice My Business (MPMB). It’s honestly such a broad topic, as all of you who have been through our training here at MPMB understand, that I simply didn’t know where to start at first. However, I will be so bold in my old age as to start with this: those who tell you to dump PPO Plans, or even a part of them, have no clue what they are talking about. Put another way, those who go through our training on how to be profitable with PPO Plans, and experience “real” profitability with their own fee-for-service fees, would never drop the PPO Plans they take.

After trained dental teams understand PPO contracts and state laws, they realize it’s not the fault of dental insurance companies that their practices are not profitable. It’s their own darn fault for not understanding the latitudes they have in those contracts and how state laws protect them from doing “free” dentistry, when they should be getting paid for the dental services they provide to their patients.

We have been honored to educate so many of you in Utah, but we still see there is work to do in correcting the misinformation propagated by so many. So many dentists “don’t know what they don’t know.” Ignorance is not bliss.

Years ago, I began teaching dentists how to be profitable with PPO plans as taught to me by Mary, the regional manager of a very “blue” dental insurance company in the US. I took a lot of heat in those early days challenging the status quo. But, I stayed the course (as so many of you have kindly stated) and pushed forward teaching truths about dental insurance contracts and state laws.

Now, if what I’m about to share makes you uncomfortable, it’s because you “don’t know what you don’t know.” Here are a few ways to be profitable with your PPO Plans, without giving away too much of what our clients pay for in our business training here at MPMB:

  1. Read, study, and understand how to apply our two helpful Utah Laws: SB 44-the non-covered services law, and HB359-the network leasing, down-coding, and bundling protections law. They really will make a difference in your practice.
  2. Read the dental PPO contracts you have signed. Below is an excerpt from a PPO contract which is similar to nearly every dental contract we have studied. When you read it, think about how this statement applies to the dental procedures you perform.
    “The provider must present the patient with an accurate and detailed breakdown of covered and non-covered services and their financial responsibility for each service whether covered or non-covered. If there are alternative upgrades to a procedure which are not covered, but the base procedure is covered, providers must explain that a covered benefit is available to the patient and the patient must sign their consent to receive any upgraded, non-covered alternative or additional services.”
  3. Stop blaming dental insurance companies for not being profitable on procedures. They, like you, are a business. They, like you, sell products and services. Stop thinking that they should cover every procedure at high reimbursement fees that are not even close to the premiums they collect from businesses or individuals for their dental plan products. Yes, I am sticking up for them on this point. It’s simple business, and many of you waste so much energy complaining about their reimbursements, when you should be simply collecting more from the patient for your services. For heaven’s sake, many of us pay thousands of dollars a month for medical, yet we still have co-pays and deductibles every time we receive medical treatment. Charge your patients for the services you perform. Learn how to be paid fairly for those services.
  4. Learn what true profitability is and how to acquire it. We continually see offices take some of the pearls of profitability we teach at our intro courses and run with them. I love it! But those are not all the pearls of profitability. Mary, the regional manager from the “blue” dental insurance company, taught me that dental practices are not profitable like they should be because of two reasons: (1) lack of business training and (2) fear. What Mary taught me early in my career has been priceless. The knowledge she shared with me is what every dental practice must know to be profitable in the PPO and FFS business we are in.
  5. Learn business skills that are laser-focused on dentistry. That business education must come from people with reputable business degrees from accredited schools of learning, and real-world dental experience. As important as business skills are, leadership skills hold the same level of importance. It’s our thought leadership that you should be armed with the business skills needed to run profitable dental practices, so you no longer need to rely on us. What a concept!

It’s time to face the facts. Your current insurance reimbursement is based on YOU providing the “least expensive professionally acceptable treatment” (LEPAT), as outlined in your contract as a dental PPO provider. This situation presents you with three choices: racing to the bottom by providing the cheapest dental care possible (resulting in financial losses), delivering high-end dentistry on a PPO budget (leading to even bigger financial losses), or a hybrid of the two (where you’re still losing money). You shouldn’t blame yourself – your education focused on dentistry, not business management. However, a more profitable option does exist: guaranteed training with MPMB.

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