31.8% of US Dentists are Planning to Resign from PPO Plans in 2025

Narrator: This is The Thriving Dentist Show with Gary Takacs, where we help you develop your ideal dental practice, one that provides personal, professional, and financial satisfaction.

Gary Takacs: Welcome to another episode of The Thriving Dentist Show. I’m Gary Takacs, your podcast co-host. The title of today’s episode is quite provocative. The title of today’s episode is 31.8% of US dentists are planning to resign from PPO plans in 2025. I’m excited to share this information with you. I’ll cite the source of that information, the scientific source of that information, and share why you might wanna be part of that 31.8% of dentists that are considering that.

Before we get into this episode, two quick announcements to make. First announcement is coming up on October 24th. We have our 2025 Reducing Insurance Dependence Annual Summit. It’s a virtual summit. It’s Friday, October 24th—Thursday, actually—five and a half hours. We’re required to take two short breaks during that time period, but the actual time goes from noon Eastern Time to 5:30 PM Eastern Time.

Gary Takacs: You’ll get five hours of CE credit. And here’s the great news: there’s no tuition. We’re waiving your tuition in appreciation for being a listener to the podcast. You do have to register. Go to RID—stands for Reducing Insurance Dependence—ri.academy to register for the course. But again, there’s no tuition. If you stay the entire length of the course, there are some CE requirements, but if you stay the entire time, then you’ll receive five hours of CE credits.

There’ll be a variety of presentations throughout those five and a half hours. There’ll be some opening keynote presentations about the whole concept, how to do it, what to be mindful of, what to avoid—pitfalls to avoid, and so on. There’ll be panels with experts. Everybody that’s part of that has been hand-selected by us because they are experts that have authority and experience in helping doctors successfully resign from PPO plans.

Absolutely everybody involved will be a piece of the puzzle and will help you navigate this successfully. Come join us October 24th. It is our 2025 RID—Reducing Insurance Dependence—Annual Virtual Summit. This is our fifth annual, by the way. Our attendance has doubled every year. We’re anticipating that again this year. That’s a big lift. We had big attendance last year, but we’re anticipating it’s gonna double again this year. Be part of that wave. Come join us.

Alright. Second announcement I have is we have a returning clinician as a Top Clinical Tip. This is Dr. Joseph Mina Atella, and he’s gonna talk about what to keep in mind when placing immediate implants. If you’re placing immediate implants, you’re gonna appreciate this Top Clinical Tip from Dr. Joseph Mina Atalla.

Dr. Joseph Mina Atalla: Hi everyone. I wanna talk about immediate implants and what you should be having in mind. The second you find the socket there and you’re trying to take your implant size and those to place the implants, here you have the tissues—the hard tissue and the soft tissue. And you have an architecture of an implant design that you have to pick and choose accordingly, that fits perfectly for that patient, for that specific socket.

I want you to think a little small. The smaller the implant, the more soft tissue and bone volume you’ll be able to have five, ten years from now. So, one of the biggest mistakes we’ve done in the implant history before last generation was picking very large diameter implants. And we used to think that this would disperse the energy better and dissipate the energy less around the neck of the implants.

Dr. Joseph Mina Atalla: With the new implant designs, with the conical connection and how tight they are, the way the energy dissipates is not on the neck of the implant, as we used to think or as used to happen with older designs. But it’s more dissipated in the space from the neck all the way to the middle of the implants because of these conical connections. More stable can be long-term success.

The implant is based on how much tissue and bone is around the implant, not how big the implant is. Just always remember that. Focus on the apical one-third of the implant for the primary stability and how aggressive the threads should be on the apical one-third, so you have the threads for the stability. And the connection is one of the best connections that we’ve had in this generation by now, for the last 15 or 10 years at least.

Dr. Joseph Mina Atalla: Conical connection can be two conemores—around six degrees like the INS—or more towards 11 like the ENT CM. And then it moves up to sometimes 12 or 16, like Drive or the Geo and other implant designs as well.

I always like picking a more tight conical connection for the teeth. When you have it, I’m not worried about this breaking down, and I need a tighter connection for the bone and the tissues to start sliding over the implant neck. In the molars, I would be more lenient—towards between 11 or 16 degrees.

Always remember the circumference. The oral cavity is the most infected part of our body. Why would you want to have that big of a circumference exposed to the oral cavity when you can have something much smaller?

For the emergence profile, yes, that makes sense. But also by compensating for it—by putting the implants a little bit deeper into the bone and a more steep angle toward the abutment—you can compensate for that primary stability or the apical threads being as aggressive as you can have, with thinner implants.

Dr. Joseph Mina Atalla: Think more tissues and bone volume around the implants through the years. Try to imagine how this implant will look 10, 15 years from now. Tight clinical connective—make sure when you’re opening the flap, you have good connective tissue all around the neck of the implants that is tightened, adhering to the bottom of the tissues.

One of the very important techniques, and one of the things that are very important from a microscopic level, is if you consider placing one abutment, one-time technique. The worst thing we can do to the abutment and implant interface is removing, putting, removing, and putting—and all the friction around these threads between the healing abutment and so on and so forth for the impression—makes a huge difference on the microscopical level.

One-time technique always helps with the Oma-like attachment that happens between the connective tissue and the base of this abutment, and solidifies a very healthy way to try to achieve the heart of these attachments as well.

I hope this helps. A quick tip. Thank you very much.

Naren Arulrajah: Welcome back to the Thriving Dentist Coaching and Action Segment. This is gonna be an awesome episode, but before I jump in, I wanna kind of take a minute to highlight something Gary said, which is the upcoming Reducing Insurance Dependence Academy Annual Summit. It’s happening on the 24th of October, which happens to be a Friday. You’ll get five hours of CE. Please don’t forget to go to RID Academy and check it out. I’m really looking forward to it.

Now, Gary, today’s topic is really an awesome topic because it’s based on some information you found, and I’m gonna let you fill in on, you know, the source of this information and all that stuff. The title is 31.8% of US dentists are planning to resign from PPO plans in 2025. 31.8% of US dentists are planning to resign from PPO plans in 2025.

You know, the Reducing Insurance Dependence Academy is having the best year yet. I think we started it five years ago, and since then, every year it seems like there’s more people interested in, you know, resigning from PPO plans for the simple fact that:

A) You only are getting pennies on the dollar when you work with PPOs because of the write-offs, and B) The patients who come through PPO are kind of like Groupon patients.

Again, that’s an analogy that you came up with, Gary, and I think that’s really apt. In other words, they’re kind of the bottom feeders. They only want dentistry covered by insurance, as opposed to all the other things. So, not that some of them won’t have Invisalign, or not that some of them won’t have beautiful smiles, but the first question that comes out of most PPO patients’ mouths is, “Is it covered by insurance?” If it’s not, they think the doctor is trying to sell me something. It’s just subconsciously—that’s the way their brain is wired because of this PPO mindset.

So, I’m really interested in diving deep into what’s happening in the dental landscape. Why are 31.8% of US dentists planning to resign from PPO plans in 2025? Like, what’s going on, Gary? So, I’m really interested in this whole topic.

Gary Takacs: Well, let’s start with the source of the data. So, the s ource of this data—and the data is 31.8% of US dentists are planning to resign from PPO plans in 2025—the source is the Health Policy Institute. Health P.I.—Health Policy Institute. You can Google it. It is an independent research organization that publishes information related to health and health policies.

They’re an independent—uh, they have an independent association with the ADA—but they are a scientific organization that publishes research. And they recently did a nationwide survey across the country of dentists—of US dentists. And that data point came from the results of their survey. And the survey respondents—there were enough respondents to allow them to statistically substantiate the report.

You know, when you’re doing surveys, Naren, you probably know this, they have to survey enough people for the data to be statistically valid. Does that make sense?

Naren Arulrajah: Yes, Gary.

Gary Takacs: I mean, if we only ask 10 people, then it’s not statistically valid. There are certain publishing requirements that allow them to extrapolate the data if the sample database size is large enough.

So again, let’s round up and call that 32%. I wanted to actually publish the 31.8% in the title ’cause that’s the amount that was reported. But 32%—that’s almost one out of three dentists—are planning to resign from PPO plans in 2025.

Now, why is that? Well, I think there’s a lot of reasons. But I think maybe the most profound reason is the combination of inflation—you know, let’s face it, everything we buy in the dental practice today is more expensive. Everything we buy is more expensive. And especially wage inflation, Naren. Wage inflation in dentistry—especially hygiene wage, although it goes across the board: administrative team members, office managers, assistants, hygienists—those wages are going up way beyond the normal cost of living increases, especially in hygiene.

Gary Takacs: And when you put those together—your inflation in your practice and wage inflation in particular—many dentists have discovered that it’s actually costing them money to provide care to patients on some PPO plans.

Because of the other trend that’s happening, Naren—and it’s absurd, but it’s reality—the reimbursement levels from PPO plans, instead of going up to factor in the increased cost of doing business, are actually going down. Insurance plans are reducing the amount of money that they’re paying.

So you put the two of those together, and it simply doesn’t make sense. It doesn’t make sense.

Now, let’s talk a little bit more broadly about this. The data on what percent of practices in the US participate with PPO plans is a bit elusive. It’s a bit elusive. However, I’ve seen a number of different independent sources that say that number is higher than 90%—higher than 90% of dental offices in the United States participate with at least one PPO plan.

Gary Takacs: There isn’t good data that I’m aware of on what percent of dental offices are completely fee-for-service. There is not good data. However, I can report that the good data says that more than 90% of the practices in the United States are participating with some PPO plans.

And, you know, I like to refer to this whole exercise as reducing insurance dependence—RID. We use that in the Reducing Insurance Dependence Academy. RID stands for reducing insurance dependence. Naren, notice that I call it reducing insurance dependence as opposed to going fee-for-service. We did not name the academy The Fee-for-Service Dental Academy. Why didn’t we name it that, Naren?

Naren Arulrajah: Yeah, because, I mean, you have given me countless examples. There are some practices with PPOs—they started dropping plans, and they didn’t go all the way to fee-for-service. Some stopped with one plan, some stopped with two plans, and it made sense for them to do that.

Because in their environment, that particular plan they kept made sense for them. You know—maybe I’m just making this up—maybe there’s a lot of government employees, and you wanna serve them, and they’re all with this particular plan. And, you know, you want to be supportive, so you make a strategic choice of keeping that plan.

Gary Takacs: The point being that you do not have to go all the way to fee-for-service to improve your practice by resigning from PPO plans. Every time you’ve successfully resigned, you have improved your practice. And thank you—every time you’ve successfully resigned, your practice got stronger financially.

And a lot of times, what I find, Naren, in my coaching work is when I’m doing a coaching strategy meeting and I’m talking to the doctor about his or her practice and learning more about the practice, I often hear something like this: “You know, Gary, I’ve got… I don’t even know how many plans I have.” That’s a common response that I get today.

And it’s not an ignorant doctor that’s saying that. It’s because of the confusing nature of umbrella plans. You know, the umbrella plans—where you think you’re under one plan, but underneath the umbrella, there’s five others.

Gary Takacs: So you think you signed up for one, but you actually got roped into six. And that’s why a lot of dentists will say, “Gary, I don’t even know how many plans I’m in.” And that’s a reality today because of those umbrella plans.

And what a lot of doctors tell me is, “Hey, I’ve been listening to your podcast, and I think with your help, I think we could resign from almost all of them successfully. But I’m concerned about Delta. I’m concerned about Delta.” That’s often the one. It could be another—it could be another massive plan. But Delta is almost always the largest. It’s not always, but I’ve seen other examples.

So you could plug in whatever name is true for your practice. It depends on the employers in your area and so on. But most of the time, the answer is Delta.

Gary Takacs: And they say, “I think with your help, I could successfully resign from all these other ones. It’s just Delta that I’m concerned about.”

I say, “Well, here’s the great news: we don’t have to make that decision today. Let’s start by picking off plans and moving one at a time. Measure our success along the way. Keep improving along the way. And then, if the only one that’s left is Delta, then we can evaluate that independently. And there may be a reason that you want to keep it. Or maybe you’re emboldened”—this is often what happens—“by the success that we’ve had.”

And success is measured in a lot of different ways. But one of the ways we can measure success is: what percent of our existing in-network patients did we keep? Did we keep? What percent?

And maybe this office is literally following step by step, and when we do the debrief at the end of every plan that we resign from, the dentist tells me, “Gary, I lost way fewer patients than I thought.”

Gary Takacs: So imagine that happening along the way. And then we’re faced with Delta. Then we can make the decision at that point.

And I always tell my clients, I say, “You know, Doctor, if it doesn’t work with Delta, we actually have a backup plan.”

We have a backup parachute. You know, if we’re a skydiver, you have your main parachute and you have a backup parachute. We have a backup plan.

They usually look at me—we’re on Zoom—and they’ll say, “Gary, I don’t remember what the backup plan is.”

And I say, “Well, give yourself some grace. We never talked about it. Let me talk about it now. Here’s your backup plan. Wait for it… wait for it… wait for it… Sign back up.”

Now, let’s talk about the consequences. If you are currently a Delta Premier provider and you resign, they’re not going to let you back in under Premier. Right? They’re only going to let you back in under PPO.

If you’re a younger doctor—and even some mid-career now—that are PPO, you’ve got no consequence to signing back up. Because you were PPO before. Now you’re PPO again. Can you sign back up?

Naren Arulrajah: So it’s kind of one of those…

Gary Takacs: Well, and can they sign back up?

Naren Arulrajah: Absolutely, Gary. And there’s no consequence, because you’re gonna get the same deal you got before.

Gary Takacs: If you are Premier, then you will get a slight haircut. It really isn’t that much to write home about, but you’ll get a slight haircut on your fee. But here’s the great news—we’ve never had anyone have to sign back up. Right? It has not happened in my coaching.

Naren Arulrajah: Especially with your coaching, Gary, I agree that people do really, really well—versus some people who do it on their own and they kind of make some mistakes, and it costs them a lot, and then they sign back on.

Gary Takacs: Planning. Well, it’s happened. It’s happened a minority of the time, but we have added coaching clients because they tried to do this on their own, and they got a little bit impatient, and they didn’t follow the protocol.

We have a six-step blueprint. It literally is a six-step blueprint. Naren, if you were a builder and the architect provided you with a blueprint, are you gonna follow that blueprint if you’re a builder?

Naren Arulrajah: Uh, yes.

Gary Takacs: Are you gonna make any modifications without the approval of the architect?

Naren Arulrajah: No, I won’t.

Gary Takacs: Do it at your own risk.

Naren Arulrajah: Yeah. I mean, usually the reason we hire an architect is to think everything through holistically. It’s all engineered.

Gary Takacs: What’s the point of engineering?

Naren Arulrajah: Yeah, it’s all engineered. And so our six—

What’s the point of paying him $30,000 or whatever and then—yeah—you know, like changing it? Then might as well not hire him in the first place.

Gary Takacs: Our six-step blueprint is engineered. Yes. It’s been proven time and time again. Granted, it’s all customized to you—it’s all customized—but it’s proven.

But we’ve added a minority of clients that say, “Gary, I made a mistake last year. I just took the leap. I did this, and now I need help. The practice is struggling.” And then we’ve gotta go back and sort of regroup and really, you know, go back to the drawing board.

And the great news is all those clients have ended up—

Naren Arulrajah: It’s kind of like, don’t try it at home. Like sometimes you see these stunts, you know, Red Bull stunts, and the first thing they put under the video is: Don’t try this at home.

Gary Takacs: Yeah.

Naren Arulrajah: You need to think it through. You need somebody guiding you to make sure it’s done properly.

Gary Takacs: You know, and to be fair—myself, or our coaching team, or some coaching group that has experience with that, you know?

Naren Arulrajah: Right, right.

Gary Takacs: But I’m encouraged by the fact that 32% of dentists in the US have said, enough, enough, enough, enough, enough.

There is a groundswell movement of dentists, as evidenced by that data from the Health Policy Institute, that have just said enough. And there’s also a groundswell movement of public support on this.

You know, there’s lots of different data points around insurance companies and the billions and billions and billions of dollars of profit they make—by not paying benefits. By not paying benefits.

Think about that, Naren. You know, I’ll get on my soapbox for a minute, but one of the things we need is massive regulation reform.

Gary Takacs: And it’s perhaps coming—but I wouldn’t wait for it. If I was a dentist, I wouldn’t wait. Because who knows—the lobbying on the insurance side? You know, they have billions—hundreds of billions of dollars—to fight any lobbying efforts to have benefit reform.

But we really need benefits reform, because right now it’s just a lopsided system. The only one that wins is the big, bad insurance company. The dentist doesn’t win. The patient doesn’t win. The company that bought the policy doesn’t win—because they’re being gouged for premiums.

There is some reform on the horizon, but I wouldn’t wait for it, because it’ll be a long time coming—because of the lobby that insurance companies could put out to fight any changes there.

So you can take care of this on your own.

Naren, we’re at a good point. I looked ahead and saw some great questions in the Q&A segment. Let’s pause here on the Coaching and Action Segment and go to the Thriving Dentist Q&A.

Naren Arulrajah: Welcome back to the Thriving Dentist Q&A segment. Gary, it’s a really timely topic, given that the Reducing Insurance Dependence Academy Summit is coming up. 31%—or 31.8%—of practice owners are thinking of resigning from one or more PPO plans in 2025. So, I enjoyed the topic.

Let’s jump into some questions our audience has sent in. Gary, question number one: My office is in a very competitive area where almost all the dentists are PPO providers. Does it make sense for me to resign in this environment?

Now, I have a thought that popped into my head. I bet these 31.8% of people live in those environments too, right? I don’t think they’re getting this data from—

Gary Takacs: Remember the data I cited in the Coaching In Action Segment?

Naren Arulrajah: Yeah.

Gary Takacs: While we don’t have an exact number, we know that more than 90% of practicing dentists—

Naren Arulrajah: Oh, so you’re saying—

Gary Takacs: It’s everywhere.

Naren Arulrajah: Everywhere.

Gary Takacs: It’s everywhere.

Naren Arulrajah: So we think it’s only unique to us, but you’re saying—no, no, no—it’s everywhere. So, if 31% of your peers can do it, so can you. At least that’s my reaction. But I want your response, Gary.

Gary Takacs: Yeah, yeah. And I can back it up by experience. We’ve done this in over 400 practices in every locational environment.

Urban—often the urban areas are highly competitive because you’ve got buildings where dental offices are stacked in buildings, and you’ve got density. Now granted, you have a dense population, but you also have a very dense number of dental offices in a small geography. Right? You know—New York, Chicago, Seattle, Los Angeles—very dense.

So we’ve done urban areas. We’ve done suburban areas, large towns, medium-sized towns, small towns, remote towns. Company towns can be the hardest to do this in.

For example, Seattle. Seattle has many employers, but the employment landscape is dominated by four major employers—in no particular order: Boeing Aircraft, Microsoft, Amazon—which has its headquarters and largest distribution center—and Starbucks. And all four of those have PPO plans.

Gary Takacs: So there are a lot of dentists, and we’ve helped dentists up and down the I-5 corridor succeed massively by resigning from PPO plans.

Another company town is Houston. Houston has a lot of large employers related to oil and gas, and they provide benefits. And that’s another town—we’ve had lots of success in Houston.

So, even in those areas… yeah, I understand your perspective, Doctor, because it matches statistically. But yes—we’ve had a lot of success with that.

Naren Arulrajah: Gary, one of the things we’re doing in this episode is we are giving away the PPO Write-Off Calculator—access to that calculator. Can you talk more about that? You know, how can someone—let’s say someone’s really thinking about it, but they don’t know what the impact of the PPO plan is from a dollars-and-cents perspective?

Gary Takacs: Yeah, let me explain that. So, there are two ways to enter your fees into your PMS—your practice management system—whether it be Dentrix, Eaglesoft, Open Dental, or any of the others.

One way is: you enter your UCR, your usual and customary fees. Then, when you get your EOB—Explanation of Benefits—you load that into your software. And then the software does the calculation to figure out what your adjusted production is.

Only 10% of dentists do that—10%. I like that method, because then we can run a report and see what you’re writing off. We can run a report, because it comes right out of your software.

90% of dentists—9 out of 10—enter their contracted fees into their fee guides in their practice management system. The contracted fees.

By the way, all the major practice management software—Dentrix, Eaglesoft, Open Dental—encourage you to enter your contracted fees. And the reason they do that is because it makes it easier to track collections.

Naren, if you had a service that was $1,000 in your UCR fee, but your contracted fee was $550, then $550 is what goes into the fee guide. What are we trying to collect in that example?

Naren Arulrajah: $550—we are trying to collect $550.

Gary Takacs: Trying to collect $550, yeah. So it makes it easier to track your collections. But the downside is—you never know what you’re writing off.

So if you’re part of the 90% of dentists that don’t know what they’re writing off, then we’ve made it easier for you.

We designed a custom Excel spreadsheet. With very simple information, we can estimate what your practice is writing off—to an accuracy of plus or minus 2%.

Let me give you an example. We did this recently with a new client of ours in our coaching. This is a practice that, in 2024, collected just over $1 million. Just over a million. And he said, “Let’s round it to a million. It’s that close.”

So:

• Collected: $1,000,000
• 82% of his patient base were PPO patients (important number that goes into the spreadsheet)
• Average adjustment: 42% (which is actually lighter than the 45–50% we normally see)

All that went into the Excel spreadsheet. Here’s what the doctor discovered:

He had to produce $1,537,000 in order to collect $1,000,000.

Now, if you’re listening to this and you just joined, you might be thinking: Oh my God, that office has a collections problem. Does that office have a collections problem, Naren?

Naren Arulrajah: Absolutely, Gary—absolutely not. I mean, collections in the sense—

Gary Takacs: They do not have a collections problem. They have an adjustment problem.

Naren Arulrajah: Adjustment—I’m sorry, I meant to say adjustment problem. Yeah.

Gary Takacs: They do not have a collections problem. They collected 99.6% of their adjusted production. I want to emphasize—not a collections problem. They have an adjustment problem.

That office—if you accept my explanation of thinking about your insurance adjustments as a marketing expense—that office spent $537,000 on marketing last year.

Naren Arulrajah: Right.

Gary Takacs: Not to a marketing firm. But who did they pay that to?

Naren Arulrajah: They’re paying it to insurance companies. And the funny thing is, the insurance company takes the money off right off the top, so they don’t even realize they’re paying it. And that’s why this is such a problem. Nobody catches it, because they’re not writing a check—they don’t feel the pain.

Gary Takacs: Meanwhile, dentists are running around trying to save a dollar on a box of gloves, you know, to improve the finances of the practice—and they’re writing off $537,000 to the PPO plans.

So if you’re in that group—that 90% that enters your contracted fees—go to thrivingdentist.com/ppo and we’ll provide that Excel spreadsheet for you.

We’ll run the calculation and send it back to you, so you’ll know what you’re writing off. And it will be sobering.

I’ll warn you to sit down before you read the results of that.

The doctor I mentioned—I said, “Do you realize you’re writing off $537,000 a year?” He said, “I had no idea. I knew it was a big number—but I had no idea.”

And now you know. And information allows you to make good decisions.

Naren Arulrajah: You bet. Great question. Thank you, Gary. I think that’s a wonderful tool.

By the way, the link again is thrivingdentist.com/ppo. So please go to that link, use the Write-Off Calculator—it’s our gift to you. And you can find out, very accurately—like Gary said, within 1–2% accuracy—how much money you are wasting.

Gary Takacs: The equation has a plus or minus 2% accuracy. So it’s very, very accurate.

Naren Arulrajah: Yeah. So take advantage of it. It’s our gift to you. You could hire a consultant and go through the whole process—or use that tool and get the answer. And that answer will help you decide: Yeah, am I going to drop PPO plans—or start dropping PPO plans—or not?

Naren Arulrajah: Let me go to question number two: One of my colleagues recently resigned from Delta and experienced a massive patient loss. What can I do to avoid this if I resign?

Gary Takacs: Well, I mentioned in the Coaching and Action Segment that we’ve gotten clients as a result of trying this on their own and failing—and then wanting some help.

The most common thing that they do is they simply send all their patients a letter. And I would suggest that the colleague this doctor is talking about likely just sent a letter. And that’s a disaster. It’s a disaster.

First of all, no one understands the letter. They don’t have the ability to ask any questions. So we communicate directly.

We do send a letter, but we don’t lead with a letter. We lead by talking to our patients about this. And we train the team on how to answer commonly asked questions—FAQs, frequently asked questions—how to overcome objections, and let them know why we’re doing this. Let them know what’s in it for them, the patient—why we’re doing this from their perspective.

So it’s likely that the office just sent a letter, and they’re thinking, “How efficient! I’ve got 1,500 patients that have Delta—I’m just going to send a letter.” Well, that will produce a predictable result, which is a lot of attrition.

It’s just not personal. It’s transactional. It’s not personal.

You’ve got to be highly personal in this to make it work—not just transactional. Sending a letter is transactional.

Great question.

Naren Arulrajah: Thank you, Gary. Let me go to question number three: What are some factors I can use to determine if my practice is ready to resign from PPO plans?

Gary Takacs: There are three major factors, and let me go through each one.

First one is: How relationship-driven is your practice? Imagine a spectrum—a horizontal line on the screen. On one end, you have highly relationship-driven, and on the other end, you have highly transactional. Where are you on that spectrum?

I don’t think any office is purely one or the other, but you fall somewhere along the line. If you are more relationship-driven, what does that mean? We know our patients’ names. We know the spouse’s name. We know the kids’ names. We know the dog’s name. We know their hobbies. We know their interests. We know that Linda—one of our patients—is taking care of an elderly mother right now.

Now, we don’t have to know that about all patients at all times. We just need to know about the patients we’re seeing today. So we have to have good systems in place for that, and team members—and doctors—who are tuned into the behavioral side of dentistry, the people side of dentistry.

The more relationship-driven you are—the farther you are on that end of the spectrum—the more ready you are to do this. If you’re highly transactional, then we’ve got to get you moving toward being more relationship-driven before doing this.

So that’s Factor 1.

If you want to test yourself on this, Doctors, I’ll give you a little subjective litmus test:

• Without looking in your practice management software,
• Name 5 patients by name who are schoolteachers (any level from K–college).
• Name 5 patients who own their own business.
• Name 5 patients that are retired.
• Name 5 patients who will retire in the next two years.

If you get crickets when you test yourself on that, then you’re not as relationship-driven as you think. It’s a bit of a wake-up call.

Naren Arulrajah: Yeah.

Gary Takacs: But if you pass with flying colors, I bet you’re really on that good end of the relationship spectrum.

Second factor is: Demand in your schedule. How far out are you booked for a new patient appointment? And I mean a specific new patient—someone who just moved to the area and wants to establish with a new dentist. Nothing urgent.

How far out are you booked?

The farther out you’re booked, the better prepared you are—because that shows demand.

How far out are you booked in hygiene?

I asked that question recently to a new client, and they were booked out nine months for a hygiene appointment. Granted, things change, and they can work people in—but that office was ready because they had demand.

Naren Arulrajah: Too much demand, so of course you can get out of this—more demand means you can drop the worst PPO plans and nothing will happen.

Gary Takacs: We still want to keep as many patients as possible, but—let the chips fall.

Naren Arulrajah: Exactly.

Gary Takacs: If I ask a doctor, “How far are you booked out?” and today is Tuesday, and they say, “I can work a new patient in tomorrow,” we don’t have the demand. We’ve got to build that up.

Naren Arulrajah: Even less than two weeks—that means they don’t have the demand. Even a month.

Gary Takacs: Ideally, a week or more is what I want. I want to be able to offer new patients an appointment within a week—that’s kind of the sweet spot.

Third factor is: Do you have marketing in place—proven marketing—to replace the patients you’re going to lose when you go out-of-network?

And furthermore, do you have a plan to replace the historic flow of patients that came through the PPO plans?

For example, if you’re getting 10 new patients a month from Delta, the day you resign from Delta, that goes to zero—you’re no longer listed.

If you annualize that—10 a month times 12 months—that’s 120 new patients a year. Do you have proven marketing in place to replace that flow?

Gary Takacs: So those are the three main factors:

1. How relationship-driven are you?
2. How much demand do you have in your schedule?
3. Do you have proven marketing in place to replace the PPO flow?

There are other readiness factors that are more minor—like:

• How relationship-driven is your team?
• How on board is your team? Are they saying, "What can I do to help?" or are they digging in their heels?

Those are important too, but the three big ones are what I just outlined.

If you’re greenlight on all three, then we can move forward and start marching through our six-step process.

If you’re not, it doesn’t mean you can’t resign. It just means we need to do more prep to be able to resign successfully.

Naren Arulrajah: Makes sense. Um, Gary, one comment—you talked about how one of the reasons people struggle is they don’t have enough marketing to replace those patients. In other words, all their patients are coming from PPO plans, and they don’t have any other way of attracting new patients.

Gary Takacs: You know, they go hand in hand, Naren. Because if you’re spending $537,000 a year going to the PPO plan—in the example I used—they don’t have a budget for marketing. So we ask them, “Hey, what are you doing for marketing?”

You know what that doctor said to me? I said, “What are you doing for marketing?” He said, “Nothing.”

I said, “No, no, no. You’re using the insurance plans for your marketing. You’re paying $537,000.”

Naren Arulrajah: Right—you’re paying $537,000 for marketing.

Gary Takacs: But his perspective was “nothing”—because he wasn’t spending money with a marketing company.

Naren Arulrajah: Yeah. So, if you want us to kind of help figure out how you can build a marketing engine—where you’re not paying half a million to the insurance plans, but rather driving patients through organic Google SEO or even ads—book a Marketing Strategy Meeting.

It’s going to be a lot less expensive than half a million.

For example, with SEO—for $15,000 or less—you can get the same benefit. You can get 20 new patients a month from SEO. That’s a fraction of half a million.

So book that Marketing Strategy Meeting: ekwa.com/msm.

Gary, what are your comments on that?

Gary Takacs: Yeah, I mean—why in the world would you spend $537,000—I’m saying “spend” in air quotes because you’re not actually writing a check, but it’s affecting you the same way—why wouldn’t you rather spend, you know, $15,000 a year and have a proven marketing system?

Why in the world? It’s a math equation.

Naren Arulrajah: Right—exactly. It’s a fraction of what you’re spending with PPO plans.

So yeah—ekwa.com/msm.

Naren Arulrajah: Let me go to the next and last question, Gary. That’s question number four:

How do I get my team on board? I think this is an excellent question. Again, having worked with you for, you know, seven or eight years now, this can be something that could trip someone up, right? If your team is not on board.

Gary Takacs: We really need the team on board. And the best way to do that is not only with deep training—training on verbal skills, training to answer common questions, helping them customize it in a way that’s comfortable for them to communicate with patients—but really, the best way to get your team on board is to talk about what’s in it for them.

And there are so many things that are in it for your team members that it’s a pretty cool conversation to have.

One of the reasons we’re doing this is: the stronger the practice is financially, the more we’re able to invest in technology and people. Use that language:

“Hey, we’re writing off $537,000 a year. The stronger we are financially, the more capable we are of investing in technology and people.”

And I might flip that around—people and technology. And by the way—you’re the people I’m talking about investing in.

Talk about their frustrations. Their frustration is when the patient just goes on a rampage because of what their insurance company didn’t do. And who are they raging at? They’re raging at your team—not the insurance company.

Naren Arulrajah: Exactly.

Gary Takacs: So we want to avoid that.

Look at negative reviews—one-star reviews. The vast, vast majority of one-star reviews—vast—relate to some payment confusion.

For example: the patient who came in five months and 29 days after their last hygiene appointment. Now, granted, we should have a system in place to catch that so it doesn’t happen. But now their claim gets denied—and they write you a one-star review because they expected it to be covered by their insurance.

How about avoiding that stuff?

So—what’s in it for them?

And if you’re curious about that, set up a Coaching Strategy Meeting with me, and I can share at length all the different things you can talk about with your team about what’s in it for them.

Go to: thrivingdentist.com/csm

If you’re one of the 31.8% of dentists planning to resign from some PPO plans in 2025, I’d love the opportunity to help you make that the most successful decision you’ve ever made.

Again, go to thrivingdentist.com/csm—it’ll be a Zoom meeting with me. We’ll talk about your readiness, and we’ll talk about what that six-step plan is and how to do this in a way that gets the best result.

And remember—marketing is part of that.

So I’d encourage you to set up a Marketing Strategy Meeting with Ekwa so that you can get the marketing in place in advance of resigning.

On that note—thank you all for the privilege of your time.

Naren and I look forward to connecting with you on the next Thriving Dentist Show.