Episode 448

The One Metric You Must Know If You Are A PPO Practice!

Host: Gary Takacs | Published Date: August 12, 2020 | Listening Time: 00:52:34

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In this week’s episode, Gary Takacs will be diving deep into a metric that 9 out of 10 dentists involved in PPO plans are completely unaware of. The title of the episode is – The one metric you must know if you’re a PPO practice.

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PPO’s are thieves that keep robbing you. That is what Gary thinks of the PPO plan. Why?

A lot of dentists are involved with insurance companies to get new patients into their practice, but they are unaware of the money they pay insurance companies in adjustments. 

An average insurance adjustment paid is between 42 – 44% of your income, and in some practice, it might be over 50%. But a general number will be between 42 – 44%.

PPO Write Off Calculator

Gary shares methods that you can use to track the cost of insurance adjustments that you are paying through your practice management system along with examples of how blind dentists have been regarding the amount of money they have paid, as insurance adjustments. 

When doctors do not know what their adjustments are it gives them a false reality of what is happening in their practice. And without this information, you can’t make good decisions.

The money you pay as adjustments should be considered a marketing fee because you pay that fee for the patient you get through insurance. A lot of dentists are afraid that if they leave the PPO plan, they will be unable to get patients. But imagine how many new patients you will be able to attract to your practice if you use the money you pay as adjustment annually for marketing your practice.

Leaving insurance is the most strategic thing you can do to have a legacy practice, a practice that will allow you to take care of people the way you would like to take care of them.

Listen to the episode now and hear Gary talk about – The one metric you must know if you are a PPO practice and how to work out how much you are paying as an adjustment to the insurance company.

Freebie 448

Do you have a question you would like Gary to answer in the next episode’s Q&A Segment? Ask Gary now!

  • 00:25 – Introduction to the episode
  • 00:45 – Announcement – MBA
  • 04.00 – What is the One Metric dentists need to know if they are a PPO Practice?
  • 04:14 – What is an insurance adjustment?
  • 04:48 – How Much did LifeSmiles pay when they were a PPO plan practice?
  • 05:40 – Why does Gary believe insurance write-offs should be considered a marketing expense?
  • 06:46 – What will happen to the practice if you don’t know how much you’re writing off to insurance companies?
  • 07:35 – What is the average adjustment percentage in PPO Plans today?
  • 08:38 – One Method of entering your fees schedule to your practice management software.
  • 09:19 – Example of the first method of the fees schedule entered in your practice management software.
  • 09:56 – The second method of entering your fees schedule to your practice management software.
  • 12:53 – What happens when a doctor doesn’t know their insurance adjustments?
  • 13:18 – Examples of how Garry helped a Personalized coaching Clients of his find out the actual amounts they are writing off to insurance.
  • 17:54 – Different types of insurance categories.
  • 19:51 – Homework Assignment
  • 24:12 – What you can do to get patients without the help of insurance companies.
  • 26;59 – If you leave a network, what does it allow you and your practice to do?
  • 29:29 – About the PPO write off calculator.
  • 46:50 – 4 tips for doctors who are highly dependent on insurance companies.
  • 31:20 – Question 1 – Gary, I have just purchased a practice and I plan on doing a practice management software conversion. Once I do that conversion, how should I set up my fee schedules inside my practice management software?
  • 35:32 – Question 2 – I really have no idea what my insurance adjustments are but I want to get a better understanding of how these adjustments impact my practice, where should I start?
  • 37:26 – Question 3 – Gary, the insight you have provided about thinking about my insurance adjustments as a marketing expense is brilliant! You mention the importance of ramping up our marketing before I resign from PPO Plans. What marketing should I do first?
  • 43:29 – Question 4 – Thanks to you Gary, I now know what my insurance adjustments are and these insurance adjustments amount to just over $500,000 per year! Ouch!!! I am considering just taking the leap and resigning from my PPO Plans now. What is your advice on when to resign?




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Gary Takacs

Gary Takacs Gary became a successful practice owner by purchasing a fixer-upper practice and developing it into a world-class dental practice. He is passionate about sharing his hard-earned insights and experiences with dental practices across the globe.

As a dental practice coach, Gary provides guidance for dental professionals on how to create a healthier practice style that lets them deliver excellent patient care while reducing depending on insurance.

More importantly, Gary’s insights are not just based on theory – as a co-owner of a dental practice, he has first-hand experience in making this transformation from a high-volume and low-fee insurance model to a fee-for-service approach that is more sustainable and promotes a patient-centric and financially healthy dental practice, and he is dedicated to sharing this knowledge with other dental practitioners via the popular Thriving Dentist Show!
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