Evaluating Dental Insurance PPO Plans (Which are profitable & which are losers)

Evaluate Your Dental Insurance PPOs

You can get control of the dental insurance plans you have joined.

You can keep your patients and make money on these plans.

What I’m talking about is evaluating the dental plans you have joined to determine the collections, new patients, total patients and withholds for each plan. You will clearly see how each plan affects your practice so you can make decisions based on facts rather than emotions.


By setting up a simple tracking system so you can monitor results.

Set up a Tracking System

Here’s how it works:

You run a report from your dental practice management software for each of the dental insurance companies you have become a member. Then, you evaluate the reports, looking at:

1. New patients and total collections – These are the benefits of joining a dental plan. You will see how many new patients the plan is bringing to your door and you will see the total collections for all active patients thanks to this plan.
2. Withholds and discounts – These are the negatives of joining a dental plan. You will see exactly how much money you lost by accepting the dental insurance plan’s reduced fee schedule. You will also see the amount of discounts you provided to these patients.

Now, here’s what makes this strategy so successful . . .

Dental insurance plans are starting to take over dentistry just as medical insurance plans took over medicine. Family physicians did not learn how to manage insurance, and eventually they lost their independence. Now, a family physician must be affiliated with a hospital in order to have access to the insurance reimbursement negotiated by that hospital administration. An individual physician cannot negotiate with insurance plans on their own.

That is not true in dentistry today.

You can learn to evaluate how each dental insurance plan performs for you – and then you can keep the ones that are profitable. And you can drop the ones that lose you money. And, you can do this based on financial results, not just emotions.

Download this Free PPO Plan Spreadsheet:  Insurance Calculations

This spreadsheet will automatically calculate your % write off for each PPO Plan – and it will provide a one page summary to help you evaluate each PPO plan you have joined.

You will enter:

  • Collections from the PPO plan
  • Insurance withholds from the plan
  • All other discounts

And it will calculate the % insurance withhold for the plan.

Next, you will enter:

  • Total patients seen that have this PPO plan
  • New patients from this plan
  • Reactivated patients from this plan
  • Total active patients in the practice

And it will calculate the % of insurance patients for you.

Finally, you will enter Total practice collections – and it will calculate the % of collections thanks to this PPO plan.

When you use this insurance calculator for each PPO plan you have joined, you can compare each plan side by side to clearly see the winners and losers.

If you would like more specific instructions to run these reports, along with more detailed explanations of why you’re looking at each of these numbers, then you may prefer to purchase my Manage Dental Insurance Report. Here’s a link to check it out:
Manage Dental Insurance Report

And, if you would like to set up your PPO fees in your Dentrix software, I have written a report providing instructions on exactly how to do that. With this set up, you will charge out your standard fee to the insurance companies and automatically charge out the allowable PPO fee in the patient’s ledger. This has many benefits that I outline in the following blog post: Pros vs. Cons of Entering Insurance Fees

If you decide you want to set up your PPO fees in Dentrix, here is the report providing the step-by-step instructions:

Check out How to Set Up Dental Insurance Plans