5 Specific Steps to Take Before You Resign from a Single PPO Plan

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, the Thriving Dentist Show podcast founder, and co-host. We have a great episode for you today. The title of today's episode is “Five Specific Steps to Take Before You Resign from a single PPO plan.” Excited to share this information with you. I imagine, many of you are, thinking about, successfully resigning from some PPO plans. And if that's part of your plan, then this episode is going to be very useful for you. But before we get to that episode, I have two quick announcements to make. First announcement is, that we have, shortly after publishing this episode, we have a thriving, dentist webinar coming up, virtual webinar, meaning you can attend from the comfort, and convenience of your home, or office. This webinar is on July 28th.

Gary Takacs: It's a one hour webinar, and the topic is, we're halfway through 2026. Why is your dental practice still behind on revenue? Again, the topic, the title is, we're halfway through 2026. Why is Your Practice Still behind on Revenue, 6:00 PM Eastern Time? So, we're ahead and do the Time translation for you. and, you can register. You have to go to thrivingdentist.com/events  and register for that one hour webinar. You'll get one hour of CE, and there's no tuition. We provide that for you. We take care of your tuition as a thank you for being a listener to the Thriving Dentist Show. So come join us on July 28th. If you're not quite where you'd wanna be midyear, this is a great webinar for you to attend. The next announcement that I have is we have a new guest contributor, for our Thriving dentist clinical tip. And her name is Dr. Ekta Pandya . And she is gonna share a tip on air abrasion. and, again, very specific. She's gonna talk about how air abrasion in adhesive dentistry boosts bond strength by 40%. If you are someone that is currently using air abrasion or maybe considering it, you'll like, Dr. Ekta Pandya's tip. No further ado. Here's that top clinical tip.

Dr. Ekta Pandya: Hello, everyone. This is Dr. Ekta Pandya. In today's clinical tip, I'm gonna be talking about air particle abrasion. Micro edge or air particle abrasion is an incredible tool for adhesive dentistry. Whether you're doing a complex restoration or a simple composite repair, it matters how you prepare your subtract. It affects your bond success. Some clinician relies solely on prep design or acid edge, but clinical research and experience show that when you use air abrasion, it increases your bond strength up to 40%. How does it work? Two mechanisms. Number one, a surface debridement or smear layer management air abrasion, removes compacts and tends the smear layer. Now, we all know smear layer is our biggest name of dentistry. When smear layer is gone, it allows the pond to adhere better to the tooth surface, and it treat into dentinal toes, help to make it hybrid layer, hence improve retention.

Dr. Ekta Pandya: The second mechanism is more important. It helps to create surface roughness, which dramatically increases the surface area and also the surface energy of the subtract, which creates the interlock between the two surfaces, hence, improving the micro mechanical retention. Now, how can you use this tool in your day-to-day practice? You can use this for direct restoration for all your composite fillings right before you etch and bond. You can also use it for indirect restorations. For your composite on your zirconia crowns, you can air break the anta surfaces before prime or sate the surface. Now, when it comes to bonding old resin into the new resin, an abrasion is a gold standard because it reactivates the resin layer, which improves the bond strength. If you're using resin based cement for your crown cementation, you can use an abrasion for your old buildups composite or ID layer to prove your bond strength.

Dr. Ekta Pandya: When it comes to minimal invasive dentistry, remove micro cracks, little bit of defect caries. I love to use it for my pit and fissure sealants because it helps me to clean up fissures right before I put in my sealants. Now, when it comes to the desired results, you wanna use the right parameters. The Illumina particle size should be 27 to 50 microns. 27 creates more like a finer controlled bond. Versus 50 gives you that extra grip for tougher substrates like enamel. The pressure should be 60 to 80 PSI. And the time should be like a short, precise burst for five seconds. That's all you need. So after you're done with air braiding, make sure you etch and rinse. You can use phosphoric acid, you can rinse thoroughly, make sure there are no Illumina particles on the teeth, because it can affect your bond and it can affect the hybrid layer. So if you're not using this tool into your day-to-day practice, give it a try because it will definitely affect your bond success. You'll act as an insurance for all your restorations. Again, this is Dr. Ekta Pandya key to bonding with confidence.

Naren Arulrajah: Hello everyone. Welcome to the Thriving Dentist Podcast. This is co-host, hope you're enjoying the week, and, I know this podcast is being released today. And, hope you had a wonderful day. And I also wanna take a minute to thank our contributor Dr. Pandya. It's, she's a new contributor, and, really looking forward to, getting to, getting more insights, from you, doctor, really appreciate you joining our community and supporting our community. Gary, today's topic is a, is a really important topic, and I know you are known as the expert, in dentistry when it comes to, dropping PPO plans when it comes to reducing the reliance on PPO plans. I know some practice owners don't drop them all the way, meaning they don't drop every plan, but they drop all the plans that are not working for them and keep one or two that do work for them in terms of the economics and, the reimbursements and so forth.

Naren Arulrajah: So I'm really excited about today's topic. Five specific steps to take before you resign from p from a single PPO plan. And I like this, focus on five specific steps to take before you resign from a single PPO plan. I know you and I have covered about, in general, the things you need to do before resigning from PPO plans, but I think this is the first time we are talking about like, the nuts and bolts and exactly what you need to do before you resign from a single PPO plan. So, I'm really, yeah.

Gary Takacs: Naren, think our listeners can think of this as a checklist to follow,

Naren Arulrajah: Right?

Gary Takacs: And literally could walk. We're gonna talk about five specific steps. This has been done through my work, in helping offices in all 50 states, successfully resign from PPO plans. And like you mentioned, an office doesn't have to go all the way to fee for service, right? To tell my clients that you don't have to go all the way to fee for service. But if your goal is to go to all the way to fee for service, then I'll be your biggest cheerleader. However, there are situations where it may not set make sense, in your community, in your employment base for an office to go all the way. But every time you successfully resign from a plan, you have improved your practice because now your discounts, your adjustments, the amount, the difference between your usual fee and your contract fee is gonna be going down. So, this one's gonna be very practical. I'm a big fan of checklists. one of the books, one of my favorite books, it's a must read in my opinion, is the Checklist Manifesto.

Naren Arulrajah: Right?

Gary Takacs: And it's actually written by a surgeon. and it's all about why checklists are so important. And so we're gonna take a checklist approach today.

Naren Arulrajah: Yeah. And I'm so glad we are doing this, Gary, because you and I have heard what dozens and dozens of horror stories where, somebody listens to your podcast, gets a few ideas, and then drops the plan, and then they are in trouble. They're in trouble, not because dropping the plan was a bad idea. Just that, like what they didn't know, they didn't know messed it up. It's like, imagine somebody doing surgery at home, after watching a YouTube video or pulling their own teeth at home after watching a YouTube video. Oh,

Gary Takacs: You smile at direct work. you do your own ortho at home. How'd that work?

Naren Arulrajah: ? I think it's bankrupt. Gary. I think they went bankrupt.

Gary Takacs: I'm not sure what the final toll was, but it was a massive bankruptcy. Yeah. Who Yay. Ortho. Do it yourself at home. Yes.

Naren Arulrajah: Yes.

Gary Takacs: Bad idea. Well, I'm gonna say the same thing. I'm gonna resign from PPO plans. Well, you might wanna make sure you follow the right steps.

Naren Arulrajah: Yeah. And I know I'm biased. I've known you for so many years now, and I've seen you in action for, at least, two decades. I know you have been helping practices for four to six years, and, there's this like, the, like, it's like that world famous chef, right? They can publish the cookbook. I don't think you can make the same resume the same way.

Gary Takacs: Gordon Ramsey would agree with you,

Naren Arulrajah: . I feel like there's something about the nuances. At the end of the day, you're dealing with people, right? You're dealing with team members, you're dealing with patience, and it's all nuances. It's all like emotion. And, there's

Gary Takacs: Really a science to it.

Naren Arulrajah: Yes.

Gary Takacs: There's, there's science, there's, there's analytics, there's data, there's science. It's not just I'm frustrated, let me bail. And sadly near, in our client base, we've had a handful of situations. Yeah. an office has started the process on their own

Naren Arulrajah: Yes.

Gary Takacs: And fumbled it.

Naren Arulrajah: Yes.

Gary Takacs: And it's had a big impact on the practice. Yeah. And then they reach out later, and say, I made a mess. Help me, help me unravel this. And

Naren Arulrajah: Yeah. Like, I remember this one particular Yeah.

Gary Takacs: It's been painful. It's been painful for them.

Naren Arulrajah: Extremely painful. I remember, I remember this one practice that dropped plans, and then the schedule was like a Swiss cheese, literally. Like, they didn't have anything to do, because,

Gary Takacs: This office lost half the revenue. Yeah,

Naren Arulrajah: Yeah.

Gary Takacs: Half, meanwhile, their expenses stayed the same. Yeah,

Naren Arulrajah: Exactly.

Gary Takacs: Lost half the revenue. Yeah. And it was all because of just doing it very haphazardly. Yeah. and without any, design very little training on the part of it.

Naren Arulrajah: And I think this is where experience helps, right? Like, they don't know what they don't know. They don't know how to do it wrong, so they did it wrong. Like, at least how to do it wrong, because you have been helping practices for like, we know

Gary Takacs: Where the landmines are.

Naren Arulrajah: Yeah, exactly. where the landmines are. So I think, I really think this is a good episode, take notes. But I do think if somebody's really serious, I wouldn't recommend they do it on their own. I would recommend they at least have a chat with Gary and, really, make sure they know what they're doing and they're doing the right way. Well,

Gary Takacs: And this Naren, I've, this has happened a number of times Yeah. Where, I have a coaching strategy meeting with a potential client Right. Know a bit about their practice. Right. And it's pretty apparent to me that the office doesn't have any readiness to do this now.

Naren Arulrajah: Right.

Gary Takacs: It's not that you can't do it someday. Right. Not in a position to do it now. Right. And I believe that advice is very effective at stopping what could be a bad outcome. Yeah. And, I'm thinking of one in particular that, the doctor, he said, well, I'm not gonna disagree with you after we've talked about this because you said, I don't think we're ready.

Naren Arulrajah: Yeah. It's kind of like running a marathon without getting ready to run a marathon. Right. It just won't work. like, it's just Yeah.

Gary Takacs: But that particular client, he became a client about three months later. Yeah. And we ended up with a really great outcome because he was able to do the prep work ahead of time. Yeah. Put himself in a position and his practice in a position to do it successfully.

Naren Arulrajah: Yeah. I absolutely get it. I think prep is everything, right? the best chefs, they talk about how much time they go to buy the right ingredients and create, have the right equipment and everything. Right. It's all the prep. Right. Even if you look at the best musicians, like, the ones like, who sell out their stadiums, this amount of time they spend on prep is unreal. It's just crazy. So, Gary, thank you for indulging me in really helping set the stage and helping understand why this is such an important thing and why everybody needs to take copious notes. But I wanna start, the big picture first. Why do so many PPO resignations go badly? So you have, how long have you, when was the first client who you helped resign from a PPO plan? Gary?

Gary Takacs: Oh my goodness. It actually goes back to the 1990s.

Naren Arulrajah: Oh, right. It

Gary Takacs: Goes back to the 19 hundreds

Naren Arulrajah: . So that's like, you're thinking, I'm thinking maybe 35 years ago at least, ?

Gary Takacs: Yeah. Early nineties is when?

Naren Arulrajah: Early nineties. Okay.

Gary Takacs: Everything started to shift in the late eighties, early nineties, but it goes back to the early

Naren Arulrajah: 1990s. Right. So, going back to that, you probably have helped I think hundreds and hundreds of practices, at least I remember you saying that. So based on that experience, what do you think are the reasons why they go badly?

Gary Takacs: Well, I think I can distill it to a short answer here. And Naren, they're simply not prepared. It's an emotional response. Mm. in other words, they look at how much money do we get off? And that number is staggering. And then they look at what they could be receiving if they had UCR fees, and they just make a knee jerk reaction and say, no, I'm just gonna resign. And so they resign without preparation. and in some cases, they will literally just send a resignation to all the PPO plans and that is going to go badly, without the prep. So the reason why, in some situations these things go badly is lack of preparation, lack of information, and a knee jerk reaction instead of a very specific plan. Imagine if you started building a complicated building without a set of architectural blueprints. Right. That's not going to go well. It's a very different project there. But it's similar in complexity. Yeah. A lot of pieces here,

Naren Arulrajah: Or if you are doing that building without the proper permit, somebody's gonna come and stop your project .

Gary Takacs: Right? Yeah. but really that's the simple answer there is, they're not prepared. It's more of an emotional knee jerk re and I understand that right. Knee-jerk reaction. It's like, Hey, I had a client tell me, Gary, I knew I was writing off a lot, but because we enter our con, we enter our contracted fees into my practice management software, in this case, it was Dentrix. So I really never knew how much we were writing off. And then we listened to one of your podcasts that showed how much we were writing off, and I discovered I was writing off $800,000 a year. Mm-hmm . $800,000 a year. The difference between contracted fees and UCR fees. And so when doctors hear that and see that and understand that, they have every right to be frustrated, smoke coming outta your ears saying, I gotta get outta here.

Gary Takacs: Yes, I appreciate that reaction, but let's do it sensibly. And when I, when I talk about successfully resigning PPO plans, there's a specific way for us to measure that beyond just the dollars. Right. And the specific way we can measure success is we wanna retain as many of those existing patients in your PPO plans as possible. Right. So we can measure it a lot of different ways, but that's one of the ways we'll measure success is, how many of our existing PPO plans in x, y, Z plan did we keep after we went out?

Naren Arulrajah: Right.

Gary Takacs: And that's one way, but when someone looks at this and sees the staggering amount, they feel like, okay, I'm bleeding. I'm bleeding from an artery here at 800,000 a year. They just wanna apply a tourniquet, yeah. and stop the bleeding. But what happens if you apply a tourniquet wrong?

Naren Arulrajah: Yeah. So,

Gary Takacs: What happens clinically? Yeah. You lose your win.

Naren Arulrajah: lose

Gary Takacs: Your leg. Lose your arm. Yeah.

Naren Arulrajah: And

Gary Takacs: That's what, that's the figurative response to what happens here.

Naren Arulrajah: Right. I think that's a great analogy. Right. Like, you are in pain and you do the wrong thing. Like, for example, you hate your job and you quit. But what if you have no savings? What if

Gary Takacs: Or no prospects for a future job.

Naren Arulrajah: Exactly. So you need to kind of do the preparation so at least things don't go from bad to worse, I think. And the other thing that happens is when it goes from bad to worse, the doctor panics, which makes it even worse. And then the team panics, which means that good people leave, that makes it even worse. So it creates this chain reaction, Dom,

Gary Takacs: It's a chain reaction. Domino

Naren Arulrajah: Effect. Domino effect. Exactly. Exactly.

Gary Takacs: It doesn't have to be that way, is the

Naren Arulrajah: Point. Yeah, exactly. like, you have done hundreds and hundreds of these successfully, and I know a lot of practices, they will never, ever go back to the way they used to be. Just once you, once you taste, doing dentistry people want to pay for and you do exceptional work and, all of that stuff, just, people don't wanna go back. So I think it is worth doing. So I think the instinct is good. It's just that I do it, with preparation. Right. Let me go to question number two, Gary. So let's jump into the five steps. So what are the five steps that you alluded to, when you introduced this topic? What are the five steps that you want owners to go through before they drop a single PPO plan?

Gary Takacs: Well, I'll number these steps then, Naren. So if our listeners are taking notes and they're making the checklist, it makes it very easy. Step number one is to know your numbers in detail for each plan you are planning to resign from. Now, let me, let me get granular with that. I wanna know how many active patients you have in each plan. By the way, I define active as a patient that's had an appointment in your office in the last 18 months. So how many of those are in your, in each plant? I wanna know the average write out, write off percentage compared to your UCR fees. Generally today it's in that 45 to 50% range. But I wanna know exactly what the write off is across your fee schedule. Is it 46%? Is it 42%? Is it 49%? What is it?

Gary Takacs: So we wanna know the average write off percentage compared to your UCR fees. Next, we wanna determine if the plan is a silo plan, meaning it stands alone by itself. An example of a silo plan is built in, or is it part of an brella? more and more plans are now an brella, which makes it more complicated. If the plan is an brella, we need to find out if the brella contract that you signed, you signed it, if the brella contract, will allow you to resign from individual plans within the brella. Or if it's all for one for all. And it's different. There's no consistency about it. It depends on the plan. When I ask our clients, Marin, Hey, this is an brella plan. Does that brella plan allow you to resign individually from plans within the brella?

Gary Takacs: Or do you have to resign from all at once? The answer I get 100% of the time is, I don't know. Yeah. Remember, it's a contract you signed, right? Right. Yeah. I don't know. Right? So we have to find that out. And it does vary and there's no consistency about it really depends on the contract. And then we, it doesn't matter. It just has a different strategy in terms of how we deal with it. I prefer 'em to have the individual in their silo. Because then we can pick off one at a time. We have to resign from all of. We just have to do the prep to make sure that works well. But there's the different details within step number one. But step number one is know the, know the numbers in detail. Step number two, I want you to revisit and enhance your patient experience, your patient experience.

Gary Takacs: If the patient does not feel like visiting your office is any different than going to a drill fill and build dental practice, then your results are not going to be good. And it's hard for you to be objective about that. But I want you to step back and be objective. Do we know their name? Do your team members recognize their name? Do we know things about them? Do we know their family members' names? Mm-hmm . The kids' name. The dog's name. Do we know where they work? Do we talk in a connected way with our patients doing any of that? Then that means we need to do some prep before you start resigning. Because otherwise, if you're no different than, an average real fill and bill practice down the street, why should they go to you when you go out of network?

Gary Takacs: When they could go to a similar office and they would accept their insurance? Thank you, Gary. Step three. We need to train each team member on their role in your practice resigning from PPO plus. This is not just an office manager job. It's not just our admin team member's job. Every single person in the practice has a role. And that includes you, doctor, every single one. So we need to train each team member on their role. This is where, a lot of, kind of the rubber meets the road with our coaching. We're, we're doing training with your team members, and in depth training with, so they're prepared. And one of the things that happens is when we go through that training, their confidence level goes up. Initially there's some team members that are very fearful about this.

Gary Takacs: Because maybe they've only worked in PPO practices and they're thinking, oh my gosh, this is so different. But now we start training them, providing the support that they need, providing the resources that they need. They develop confidence when they're confident in talking about this. The results improve, dramatically. step four, find out what the patient copayment will be for an adult hygiene appointment once you resign. This is a sticky detail. What fee is the patient most sensitive to when you resign from PPO plans? The adult hygiene appointment, right? Because when you are in network, typically their copayment is zero,

Naren Arulrajah: Right?

Gary Takacs: As long as they haven't come in less than six months since their last one, it's typically zero. And now there may be a copayment. We need to know what that is. let me give you an example there. within, plans in a practice that we recently had a lot of success with, there were, plans that the patient copayment was in the $12 range. $18 range. 22. Mm-hmm . 28. Another plan for that. And that's the copay. Now it means it's gonna cost the patient a little bit of money to visit. Right? Another plan within that same dental office, the co-payment was $149 on a particular plan.

Naren Arulrajah: That's day and night, right? $22 versus $149.

Gary Takacs: Remember, it's twice a year. Yeah. Let's

Naren Arulrajah: Do, yeah.

Gary Takacs: If it's a spouse, there's two people on the plan. Yeah. Plan.

Naren Arulrajah: So you need to think it through, right? Let's say you have a hundred patients and 50 of those patients are gonna have a large copayment. Then you have to decide, is that a risk we're taking? And now, if it's a small plan, you don't care. But what if it is your largest plan? Right? So you have to like, think through the implications of, what this might end up doing to your practice.

Gary Takacs: And all that means when the, when the differences are so great among plans, the employer is the one determining that, right? I should, I should even back up. It's, it is the employer that's determining that, the copayment amount, because some employers don't wanna pay much for benefits for their employees, right? If they don't wanna pay much, then the copayment iss gonna be higher. If they're a company that values their employees, Tesla is an example of that. Tesla, I, a number of examples of offices in Austin Tech, Tesla's headquartered in Austin, where Tesla has bought a very good policy dental insurance policy for their employees because they wanna attract and keep the best people. Yeah. Not every employee, employer, follows Tesla's mindset on that. And lemme go to step number five. And this will, we'll talk more about this, you'll talk more about this as we go there.

Gary Takacs: But step number five is strengthening. Strengthen your practice marketing before you resign. Emphasis on, before you must have a marketing source in place to replace patients. You're gonna lose, when you resign from PPO, you're gonna lose some. You're also going to lose the historic flow of patients that have come in from some of these plans. The worst thing in the world you could do is not put the marketing in place before. If you wait till you put it in place after you've lost more patients than you expected, then you're operating from a tremendous vul, tremendously vulnerable position. You wanna do it ahead of time. So those are the five steps. and consider that your checklist. Lemme recap. Just for everyone's benefit. Step one, know your numbers in detail, right? Step two, strengthen your patient experience process every which way. Step three, train each team member on their role in your practice resigning from PPO plus. Step four, find out the exact amount of the copayment. Once you resign for an adult hygiene appointment on every plant. That one takes some effort. And step five, strengthen your marketing first before you go out of network. So you're operating from a position of strength.

Naren Arulrajah: Thank you, Gary. Appreciate it. Let's continue this conversation. I'm really glad you repeated it because I'm sure some people are wondering, I missed that one step. So, by the way, if anyone wants to talk further about this, I would strongly recommend booking a coaching strategy meeting with Gary. And the link is thrivingdentist.com/csm . Or, reach out to us if you just want these five steps, we can send it to you. We'll send you like a PDF with these five steps. But either way, I really think you need to take this very seriously. This is a wonderful idea, a powerful idea. Dropping PPO plans, but doing it wrong could really hurt you. Gary, let me go to question number three. How long should these five steps take? I know, some of it is preparation, so it's a tricky question, right?

Naren Arulrajah: In other words, making it relationship driven, getting your marketing ready, those are common things you have to do regardless of whether you drop one plan or 15 plans. So that some of those are like common things. And then there are some things that are very specific, like finding out the copayment of that particular insurance plan you're gonna drop for hygiene visits, right? So give me your answer. I know it's a nuanced question. There's no one answer. So how would you respond to that, Gary?

Gary Takacs: Well, I would like to do this as quickly as possible.

Naren Arulrajah: Of course,

Gary Takacs: I would like to do it, but, I would actually encourage our listeners to frame it a different way. The way I'd like you to frame it is, as quickly as possible to get the desired result. Mm-hmm . If you wanna go as quickly as possible, just send your resignation to all of 'em. Then there you go . But now we gotta, clean up on IL five,

Gary Takacs: Got a cleanup project. Yes. So, yeah. As much as I'd like to go, quickly, I would like to set our timeline based on what we think is gonna take in your practice to get the best result. And I'm, I'm very pleased to say, as I guide clients through this, I'll ask them, let's say, doctor, ideally, what's your timeline on this? And I like it when I get an answer like this, Gary, as long as it takes to do it, right? Yeah. Right. Now, I have plenty of examples. And again, it depends on how many plans we have. If we have fewer plans, it can be quicker. If we have also,

Naren Arulrajah: It depends on how good, how well they are, right?

Gary Takacs: Some offices have a larger percent of uninsured patients.

Naren Arulrajah: Yeah, exactly. So

Gary Takacs: They already have this cushion, from that.

Naren Arulrajah: Exactly.

Gary Takacs: Lots of nuance, lots of

Naren Arulrajah: Variables. And some offices are already relationship driven. you read their reviews and people love the practice. So it depends on like their current situation and also where they're trying to get to. Right, Gary?

Gary Takacs: Yeah. No, absolutely. Yeah. but, we have done it, in a year or less. We have, we have plenty of clients that we've been able to do, go walk through the entire process, in a, in a year. Yeah. that would be on the fast track side, right. and, we have others that it looks like, over time, step by step by step, all the while, adjusting, refining what we're doing, to more like 18 months to two years.

Naren Arulrajah: Yeah. Like some clients, I know on the extreme example, the people who need more time, they don't have a solid marketing, they don't have a good way to book these patients. The team is not trained well on how to handle non PPO patients. So it all depends on all the things that have to kind of be taken care of before they're ready. And also, some clients only wanna drop one plan, and some wanna drop everything they can, so it all depends on the situation. So I think a

Gary Takacs: Lot of variables,

Naren Arulrajah: Lots of variables, a lot of variables. And I think this is something you do, Gary, when you work with a coaching client. I just want to amplify it. Like, you literally sit down with these clients and figure this out, figure out, given where they want to go. And again, you don't like cleanup on I five, so that's like a no-no. That's not, if you work with Gary, that's not something he's gonna be happy with. So without cleanup on cleanup in L five, how do you do this where the doctor is happy, the team is happy, and of course the patients are happy.

Gary Takacs: I always respect the doctor's decision, right? There's a choice. Yeah. but as long as you're making an informed decision, then let's go. Yeah,

Naren Arulrajah: Exactly.

Gary Takacs: Yeah. But most of the time they'll come. How long do you think Gary would take to do this? Right. as a, and I'm, I'm, I'm happy to, use that plan because I really want, I want the best possible outcome.

Naren Arulrajah: Absolutely. Gary, thank you for that. I really appreciate that. And then, which plan should the drop practice drop first? I know this is another big mistake you have shared with me that owners make, and the typical instinct is to drop the painful one or the biggest one. Right? Usually the biggest one is the most painful one for a lot of doctors. At least that's what we have seen.

Gary Takacs: That's often the instinct. That's the knee jerk reaction. Yeah. This one has the highest number of patients and the highest discount. Yeah. I'm gonna drop this one. Yeah. and actually, I would encourage you to look at a different way, if at all possible. In many cases, we'll have some small plans. By small, I'm talking about the number of active patients. Remember that, know your numbers. Yeah. A small number of active patients. Recently, this is very fresh in my coaching. There was a plan within this practice that had 22 patients on it. It was a good, strong solo dentist practice, but had 22 patients. Yeah. and so really, while it might seem odd to start with that practice first, we started with that one first because it was the idea of getting some practice in, and on a low risk, resignation.

Gary Takacs: I told the doctor, I said, you guys are prepared for this. You're ready for this. But if it's a worst case scenario and you lose all 22 patients, that wouldn't be a crisis. That wouldn't be good . Mm-hmm . But it would not be a crisis. and in turn, what happened? I said, now we use that as a building block. This particular office, they kept all 22, 100% of those. And that was a real confidence builder for the team. As we move forward, it's kind of like a dress rehearsal before opening night. If there's a play, a new play opening on Broadway. Naren, do you think they did some dress rehearsals before opening night on Broadway?

Naren Arulrajah: No. They did a lot of dress rehearsals. Gary, they did

Gary Takacs: A

Naren Arulrajah: Ton of dress rehearsals. Like, I was just imagining, or I remember the stories I've heard about Michael Jackson before. He is a concert man. He drives people nuts. He's just PI this, he has rehearsed for some stuff for an ear. literally an ear.

Gary Takacs: The modern equivalent of that is, Taylor Swift,

Naren Arulrajah: I guess. So, yeah. These people don't,

Gary Takacs: Having attended, a Taylor Swift concert with my daughter, I can assure you,

Naren Arulrajah: Oh, is

Gary Takacs: The preparation that went for this was unbelievable because the performance was unbelievable. Yes.

Naren Arulrajah: Yes.

Gary Takacs: So think of it that way. ? Yes. You, we typically look, there's a lot of, again, a lot of variables. but we tend to start with lower risk plans. And then we work our way up, to the larger ones in terms of patient count down there. And I'm gonna switch gears and put you on the hot seat here with question number five. so the marketing engine has to be in place and has to be ready. We have to have marketing in place, before you can start dropping plants. Because you're, you're gonna lose patients, you're also gonna learn, lose the historic flow of patients that have come from that planet. So, for example, if you're getting 20 new patients from a particular plan, when you resign, that number goes to zero because you're delisted from their website. Right? So 20 times 12 is 240 on an annual basis. So from the marketing side, what needs to be in place before step five is even considered possible before we start resigning what needs to be in place.

Naren Arulrajah: Absolutely. Gary, that's a wonderful question. And I, and I want to get into this. So the first thing, Gary, is I'm gonna give you the most important things first, and then I'm going to give you the second, order bit. In other words, the second most important thing. The first most important thing is people have to, these new patients have to find you, right? Because remember, you're dropping the PPO plans, so they're not finding you through the PPO plans. So you need a way for these new patients to find you. So for example, how do people find you for implants or for Invisalign, or even for emergency dentistry today? They use search, 95% of searches Google, and there are four parts to it. Google Maps, IO view, AI mode, and regular SEO, and you need to dominate it. So people are using Google 12 billion times a day.

Naren Arulrajah: So anything, everything to do with, everything you do in dentistry, whether it's AI or maps or regular search, you have to dominate. Google is 95%. The other 5% is chat, GPT and Perplexity and Gemini. So of course, don't ignore these other three, even though they are only 5%. So you need to dominate. So that means a hundred or more keywords have to rank. And I do think that's a good place to start, because now you have an abundance of patients who are finding you without having to click on an ad. See, ad patients are like patients with doubt. So you don't want to go there and even everything gets harder. You have to convince them. And if a practice hasn't even learned how to convince people who trust you, they will not convince people who don't, who doubt you because they clicked on an ad. So that's number one.

Naren Arulrajah: Number two, Gary, is reviewed. Remember you talked about patient experience. And a lot of that patient experience shows up in the form of reviews. So, and that's partly it's how good you are. And partly it's the process you have for getting those reviews. So you wanna get 10 or more five star love letter reviews every month. Let me explain 10 or more. Five stars, meaning they're giving you five stars and what I call a love letter, which means they're writing a paragraph saying why they appreciate your practice. And you want to get that on Google. Google Maps every single month. That's a minimum in our, if you're a much bigger practice, that number might be higher, but minimum 10 or more. And last, but not least, Gary, you have to know how to convert, which means the way your phone is answered, right?

Naren Arulrajah: Today, the average dental practice is only booking one out of three new patients. And you have to get good at booking 70%, 80%. So a lot of clients before they drop plans, the mutual clients Gary and I have, first thing we do with them is to launch their website. We get them to show up and dominate Google, dominate chat, GPT. So they are really getting a lot of patients who are finding them without clicking on an ad. The second thing we do is we focus on reviews. So Gary puts a system in place where they're getting 10 or more five star level two reviews. And the third thing is, we work on their calls. Now the phone is ringing. But if they're like any average practice, they're only booking one out of three new patients. And specifically they don't know how to deal with people who are outside of PPO plans.

Naren Arulrajah: Meaning this team was never trained. This team doesn't know how, it's like, it's like, imagine working at McDonald's versus working at a high-end restaurant. Just need to teach them different capabilities and skills. So those to me, to me, are the fundamental things Gary, I would focus on. And then of course, marketing never ends. So you want to keep going. And there's a, you need to keep looking at these metrics and keep improving it. In other words, last but not least, you need a system that makes these three areas improve all the time. Now, if you want us to do an in-depth study on how well you are positioned to drop PPO plans, meaning is your marketing strong or not strong, then book a marketing strategy meeting. The link is ekwa.com/td . That's ekwa.com/td  for a thriving dentist. Our team will do all of this for you, tell you how you are doing in these areas, and also give you a roadmap, a plan on how you can do extremely well in marketing, and how you can dominate marketing. So that's kind of where I would leave. Again, lemme go

Gary Takacs: Down into the review component. I'm gonna ask you a really blunt question. Mm-hmm . some offices are into review. Some offices are, how do you feel about today as we're recording this in 2026, an office that has less than a hundred reviews, a hundred reviews.

Naren Arulrajah: I think Gary, that office is disadvantaged. They have work cut out for them. It's kind of like, imagine a dentist with one year out of university versus somebody who has been doing it for a long time. The one who has been doing it for a long time, has experience, has reviews, has cases. So they, like if a patient is gonna choose someone, who are they gonna choose? Right? The one who has more of it. So same thing with reviews. So I do think Gary a hundred is like the bare minimum, but I think they need to keep getting the 10 a month. So in one year they will have 220 a month, 30 years, they will have 340 a month. So I know it's not like the end of the world that they have a hundred, but they need to take getting those 10 reviews a month, five style level letter reviews, very seriously.

Gary Takacs: So how do you feel about this one, Naren? It was a call that I was on earlier, a Zoom call I was on earlier day with one of our coaching clients mm-hmm . And I was with the two doctors in the team, and they said, Hey, Gary, are you gonna come to our party coming up? And I said, well, I might have missed the invitation. Am I invited ? Absolutely. I said, what is this party for? They said, well, we're seven reviews away from a thousand. Oh,

Naren Arulrajah: Wow.

Gary Takacs: Seven reviews. This is one of our coaching clients. Yes. And when we started, they were at a couple hundred. How do you feel about that?

Naren Arulrajah: I love it, Gary. Like, I, that's what we want. See, if you really look at this whole idea of dropping PPO plans, people are choosing you because you are good. People are choosing you because you are worth their dollars, right? So reviews is a huge testimonial or a testament to that, of course, just because you do good work's voice,

Gary Takacs: You're leveraging the patient

Naren Arulrajah: Patient's voice. Exactly.

Gary Takacs: And I know some doctors look down their nose at reviews, it's like, play that game. Right? Well choose not to play that game at your own risk.

Naren Arulrajah: I agree. And I was talking to a friend of mine, he's a CEO, a very smart guy. He knows marketing. He does it for a living because he built successful businesses. And he's like, I chose a practice because of the reviews. And by the way, before I left, they wanted me to write a review. So he knows there's a system in place to turn that happy experience into a review. So it's not just providing a happy experience. The other system that you teach is how do you turn that experience into a review?

Gary Takacs: Yeah. Well, I understand the way some people feel about reviews. Yes. Now I can understand that, but that doesn't matter. because if you wanna, if you wanna rank on Google, play the review game, and

Naren Arulrajah: I think, what's a quote, right? The only constant is change and death. Like the world is changing today, whether you like it or not, people use reviews to decide whether they're gonna come to you or not. You can resist it, you can argue about it, say it's wrong. What? That's just how the world works.

Gary Takacs: And there may be a time in the future where it's gonna be something else. Yeah,

Naren Arulrajah: Exactly. And then we have to change along with it.

Gary Takacs: Pivot. Yeah. Well, this has been a fun episode. five specific steps to take before re resigning from a single PPO plan. I'll simply reiterate what we've talked about. If you'd like some help with that from a coaching standpoint, we are accepting new clients of thriving dentist coaching. just go to thrivingdentist.com/csm . That'll open up my calendar. Pick and pick a time. We'll do a zoom call. I'll get to know your practice. I'll begin to get to know your practice, and we can talk about how ready you are for this. but I would suggest that we get a really good ROI, when we help our clients successfully resign from PPO plans. If marketing is your issue and needs more new patients, then I would highly suggest that you set up a marketing strategy meeting with that. Go to ekwa.com/td 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.