Before You Drop PPOs, Prepare This (E.322)

“Good luck replacing your demand before you remove it.” – Regan Robertson

Brief Overview of the Episode

Going out of network is not a quick switch. It is a strategic transition that requires planning, clear communication, and the right internal systems long before the first contract changes. In this episode, Regan Robertson and Sara Hansen unpack what doctors need to know before taking that step.

• Why going out of network is a marketing and communication decision, not just a financial one
• What practices need in place before removing insurance-driven demand
• How team preparation shapes patient confidence during the transition
• Why the strongest shifts happen with a long runway, not a rushed move

What This Episode Reveals

• Insurance often functions as a hidden marketing channel for the practice
• Dropping PPOs without replacing demand creates avoidable risk
• Team language can either protect trust or create confusion
• The transition works best when the practice prepares well before making the change

What You’ll Learn

• How to evaluate your patient mix before changing insurance participation
• Why team training matters in an out of network transition
• How internal marketing helps replace lost demand
• Why the language around coverage, contribution, and value matters

If This Sounds Familiar

• You are considering dropping one or more PPOs but do not know if the practice is ready
• Your team struggles to explain out of network care in a clear way
• Insurance write-offs are hurting the business, but making a move still feels risky
• You want more control over growth without creating confusion for patients

Next Steps

1. Review your patient mix and reimbursement rates before making any insurance changes.
2. Train your team to talk about value, insurance contribution, and patient options with clarity.
3. Strengthen referrals, reactivation, and patient communication before removing a demand source.
4. Schedule time with Sara if you want help building the marketing strategy behind the transition: Schedule Here
   

TRANSCRIPT

[00:00:04] Regan Robertson: It essentially acts as a marketing arm for you. So when you are no longer exactly in network, you’ve gotta think about things from a different angle. Thanks for tuning into the Everyday Practices Dental Podcast. I’m Reagan Robertson, my co-host Sarah Hanson.

[00:00:17] Regan Robertson: And I interview real dentists and experts who grow their dental practices using authentic marketing in a way that you can remember, repeat and use in your own practice to get the patients you deserve. Let’s dive in. Doctor, are you ready to go out of network? You’re ready to take the step, but you’re not sure if you’re prepared, especially if your marketing is prepared.

[00:00:37] Regan Robertson: If so, this episode is totally for you. Uh, my co-host Sarah Hansen, just presented in front of 200 doctors the other day, uh, giving the presentation about volume versus value, how to be thriving in a practice that is going out of network. Sarah, I am super excited to dive into this topic with you.

[00:00:57] Sara Hansen: Hey Reagan.

[00:00:58] Sara Hansen: Me too. [00:01:00] I have been hearing, I, I mean, and I’m sure you hear it too, but we’re hearing in the industry, should I go out and network? Is it time? You know, and this is why we kind of developed some of these strategies to talk about with doctors so we can start having the conversations with them.

[00:01:19] Regan Robertson: I mean, I’ve been present for, you know, I’ve seen firsthand doctors who just go all out.

[00:01:23] Regan Robertson: So if you’re just thinking about pulling the trigger and going completely fee for service, I’ve seen the results of that. And, and it’s, it, it falls in two ways. Those that are prepared, and I mean, like months long prepared usually have a, a. Far greater chance of succeeding in that fee for service endeavor versus the ones that don’t.

[00:01:41] Regan Robertson: But there’s a big gray area in between that. It’s not necessarily an all or none situation. And as you know, productive Dentist Academy, CEO Victoria Peterson says, you know. PPOs are not inherently evil. Like there is a strategy to crafting that revenue mix in your practice. But for you [00:02:00] and me, let’s focus on the marketing element of that, especially because, uh, you know, that’s what insurance it, it essentially acts as a marketing arm for you.

[00:02:08] Regan Robertson: So when you are no longer exactly in network, you’ve gotta think about things from a different angle. So I was. Tell me a little bit about the strategy and how you approach it, you know, in the practices that, that you’re helping go through this transition.

[00:02:21] Sara Hansen: Yeah. Well, first of all, doctors, you might be a little surprised to know that we encourage an 18 to 24 month runway to do this successfully with the least amount of attrition.

[00:02:35] Sara Hansen: Um, it’s not a. Today we decide that we wanna go out and network, and tomorrow it’s happening, right? You really need to have a strategy. And so Reagan, I’d love to walk you through some of those, those pieces that, that we implement with doctors, um, on how, how do we do this successfully? Because I know it is very scary for doctors to make that transition [00:03:00] because again, if they look at the numbers, so.

[00:03:03] Sara Hansen: Again, that’s one of the pieces, doctor, that I would tell you in the very beginning. One is look at the numbers within your practice software. How many patients do you have per insurance? Um, understanding that data will help you understand the biggest impact. And at that time, you know, if you have a lot of patients on a particular.

[00:03:25] Sara Hansen: Network. Maybe Delta I know is a big one, but maybe through Blue Cross. Blue Shield is smaller. Start with the smaller ones first. Get your feet wet, get the language shifting for the team. You know, you don’t have to dive right into dropping everything all at once. We can do this in baby steps.

[00:03:44] Regan Robertson: Well, baby steps is really, is really good.

[00:03:46] Regan Robertson: And I don’t know if it’s shocking if an 18 to 24 month timeline feels shocking or not. You know, I can think of some dentists who they plan that far out. And so it’s not a, it’s not an issue. But there are others that are, you know, more impulsive and in the moment. And when they’re [00:04:00] ready to go, they’re ready to go.

[00:04:01] Regan Robertson: They’re ready. So what are some of the steps at that beginning phase, like you’re saying, okay, perfect world scenario. You’ve got the 18 months. Where do we start?

[00:04:11] Sara Hansen: First, again, identify your patient mix. So you wanna know how many are, are already, um, unrestricted with you. They’re coming with you because they already love you, you know?

[00:04:22] Sara Hansen: Um, and then the other piece is then identify how many are on specific insurances. Also, look at the reimbursement rates, because sometimes. We are not an all or nothing type of strategy. Sometimes it makes sense to still be in network with specific insurance companies, right? If the reimbursement rates are reasonable to your practice, then you know, and everything seems to be functioning okay.

[00:04:49] Sara Hansen: It’s, it’s okay not to transition off. So again, I, I think every strategy looks different for every practice based on the practice goals. So understanding [00:05:00] first, how many patients will be affected. I put that in quotations, affected, right? Meaning those are the patients you’re going to have to start conversations with.

[00:05:08] Sara Hansen: The reason why we like to say 18 months is that gives the patient three opportunities to hear from you and your team. Why you are changing your relationship with the Den or with the insurance companies? Because what happens is the moment that you tell an insurance company that you are now going to be unrestricted with them, they then immediately will send.

[00:05:35] Sara Hansen: A letter to the patient saying it’s very fearful for them saying, your provider can no longer see you. They are out of network. You know, you need to find a new provider. And oftentimes they will even send them other dentists to see. So what you wanna do is get ahead of that, right? And by having those three recare cycles.

[00:05:55] Sara Hansen: Where you can start planting the seeds, having the conversation with those patients, [00:06:00] because going out of network is really an educational campaign to our patients. It’s helping them understand what does it mean to go out of network and how does that affect them.

[00:06:13] Regan Robertson: Ooh. Okay. So let’s talk about this from the marketing channel.

[00:06:15] Regan Robertson: I’m the al, so from, from, yeah. Ation standpoint. I love that you called out three recare cycles. Mm-hmm. So there’s multiple opportunities in practice. Um, what are, what are some of the, do you start to announce this? Internally first, before you start to even alert the patients. And then, yes. And then can you take that through the, through line with me?

[00:06:37] Regan Robertson: So, uh, uh, you know, thinking about all the marketing tactics available, internal and external mm-hmm. Can you be my eyes and ears and walk me through Yeah. Guide that. Okay.

[00:06:46] Sara Hansen: Yeah. Yeah. So Doctor, let’s say you’re really starting to think about you want to go outta network. You’ve looked at maybe some of the metrics in the practice.

[00:06:55] Sara Hansen: First and foremost, we’ve gotta get the team on board. This is an all hands [00:07:00] on deck type of strategy in the practice. Again, the conversations are going to be happening with team members, but also you need them to be on board with. What this looks like, how it’s gonna look and fill. You wanna make sure that you, um, have implemented either a membership plan in your practice, maybe financial solutions through third party companies, right, where it allows the patient to make payments.

[00:07:24] Sara Hansen: Again, you want to have those other options available so that the patient now has options instead of just paying. Either full fees or, you know, things like that. So again, this is where so much of, how do I say this? Preparation work kind of goes into making that decision once the decision is made. Yeah, let’s get the team on board.

[00:07:46] Sara Hansen: How does that look and fill for each of them? What do those conversations sound like? Um, and then what I recommend doing to teams is start by shifting your language with the patient. So. [00:08:00] We can dive deeper into this too, but when we talk about language shifting, it is so crucial for our team to understand how to properly communicate to our patients by using the words.

[00:08:13] Sara Hansen: Um, what does your insurance contribute instead of covers? Um. Things like that. And if we start talking to the patients, con is so much more accurate. Right, right. If they’re not covering anything,

[00:08:27] Regan Robertson: I mean, let’s, I, I mean, I’m laughing at that ’cause I’m thinking about, you know, some estimates that I’ve seen and I thought, oh, so it doesn’t really like cover the term

[00:08:34] Sara Hansen: cover.

[00:08:35] Sara Hansen: No it doesn’t. And like, it’s so funny. I mean, I’ve been in dentistry since like 1999 and you know, at that time I believe maximum out of pocket that the insurance covers was a thousand or 1500. Right? Well, guess what? It’s 2026 and they are still only maximum covering, if you will, a thousand to $1,500. I mean, you know, [00:09:00] this is way too long that we have had.

[00:09:04] Sara Hansen: Really no. Support for our patients when it comes to insurance, right? Mm-hmm. And so really starting to shift that language with the patients early on, you know, using that terminology in the practice when you talk to a patient about their current insurance benefits, right? What does your insurance contribute to your dental treatment that now sounds exactly what it should be, instead of covers, when we use the term covers, it’s like, oh, well they should take care of all of this.

[00:09:31] Sara Hansen: Oh, and if they don’t cover it, right? It just, it is kind of that like. Negative, um, conversation towards the insurance where we have to call it out for what it is. Then that way, whether you’re, you know, unrestricted or in network, then you still have that same conversation of what does your insurance contribute?

[00:09:53] Sara Hansen: Because either way, even if you’re out of network, they’re still going to contribute something, right? So again, that [00:10:00]conversation never changes regardless of your relationship with insurance companies.

[00:10:05] Regan Robertson: So when we switched over into marketing and we’ve got this lovely runway, how much mm-hmm. Budget should a a, a practice, say a solo practice, uh, contribute to its, um, its marketing budget so that it can understand that that’s what they’re gonna be responsible for themselves in gaining the fee for service patient.

[00:10:25] Sara Hansen: I would recommend a lot of your budget goes towards team training. That is going to be your make or break. I will tell you if the team is aligned, they understand the verbiage, they understand how to talk to patients, they understand, um, how to talk about the membership plans, the benefits to the patient, right?

[00:10:47] Sara Hansen: All of those conversations will now guide the patient into what they should be doing. I’ll tell you, Reagan, it was kind of heartbreaking today. I, um, was listening to some phone calls [00:11:00] from a client and they’re trying to figure out, you know, where there is some breakdowns in the practice. And so I was listening to some recorded calls and.

[00:11:08] Sara Hansen: They are, this particular office is in network with two insurances. However, the conversations that I heard from the admin team was really heartbreaking because a patient would call and say, Hey, you know, I’m a new patient. I’m looking to have a, a specific service done. Do you take Blue Cross Blue Shield?

[00:11:29] Sara Hansen: Right. Or whatever it is. And the, the admin team would instantly say, well, we’re out of network with them. And the patient will say, well, what does that mean? Well, it means that you’re gonna have pay out of pocket. And that literally was the conversation and I was like, oh my gosh. Like there was so much more to that conversation because at one point the patient even said, well, I’m happy to pay out of pocket, you know, if I know that this is the right treatment.

[00:11:57] Sara Hansen: And yet that was never offered [00:12:00] meaning. It was never offered. Why don’t you come in and talk to our doctor? Let’s get you in for a consultation. Let’s see what this will actually be so that you know, it sounds like finances are important to you. We wanna make sure that we are maximizing everything that your insurance contributes to any dental treatment that you may need, right?

[00:12:17] Sara Hansen: This is a bigger conversation that we’d love to sit down and spend time with you. So again, and then what happened is the patient hung up and called another practice. So. Investing in your team is crucial to having, again, the, the maximum amount of patients not leave the practice, but also as you have new patients, finding you that those conversations are now resonating to the patient.

[00:12:40] Sara Hansen: So when I said that this really is an educational campaign, we’re not only education. Educating our patients, but we’re educating our team members on what it sounds like to have really great conversations with our patients in regards to being unrestricted with insurances.

[00:12:57] Regan Robertson: I love that you call it

[00:12:59] Sara Hansen: an education [00:13:00] campaign.

[00:13:00] Sara Hansen: Mm-hmm.

[00:13:00] Regan Robertson: And my mind immediately went into implementation and so, and so there’s, yeah. How do we define investing in our team? So what I heard was, you know, making sure that they have that education around them. So, so Sarah, what does this look like? It looks like to me. That means you are setting aside a certain amount of hours per month to work with the team.

[00:13:20] Regan Robertson: Yes. Be at a, a lunch or a meeting or whatever. So that could mean losing some practice hours, um, in addition to the regular meetings that you have in place. Um, I’m also assuming that it could mean bringing in a coach that, um, that can work with you or a marketing agency that can work with you. That specifically focuses on the team education training.

[00:13:42] Regan Robertson: Part, what am I missing? What else do you slot into the team training budget?

[00:13:49] Sara Hansen: I would put in the team training budget. Um. Looking at those internal marketing systems as well. So do you have the internal systems [00:14:00] to execute really great referral programs? Are we, you know, reaching out to those patients that have quietly disappeared right through a re-engagement program?

[00:14:10] Sara Hansen: Um, again, what, what you’re trying to do with not only that educational piece with the team. And the patience is we want to prepare. So we want to get ready for maybe some attrition. So we want to create volume before we have it, right? So what we’re doing is we are creating systems internally that are going to help boost up the volume of the practice.

[00:14:35] Sara Hansen: It already is a really great, valuable way to grow our practice. So whether you’re going. Out of network or not. It’s still great systems to have regardless, but what we’re trying to do now is build up those internal systems to help create for that lack of volume that could potentially happen. Now doctors, if you are currently writing off 30, 40% from [00:15:00] insurance companies, and even if 20% of your patient base left tomorrow, you’re still coming out ahead.

[00:15:08] Sara Hansen: When we kind of look at the math that way. But again, we wanna make sure that we are creating the value and the practice that you know, will help grow the practice organically, but also in a way that we’re not reliant on insurance companies as that marketing directory, which is basically all insurance companies.

[00:15:28] Sara Hansen: Are we doctors?

[00:15:30] Regan Robertson: Did you mention software in there also? Yeah.

[00:15:33] Sara Hansen: Mm-hmm.

[00:15:33] Regan Robertson: What types of software might a practice already have in place and not be optimizing it?

[00:15:38] Sara Hansen: Yeah, so teams, if you have dental intelligence, um, practice by numbers, you know, any of those that really will pull the analytics of the practice, it will give you those metrics.

[00:15:52] Sara Hansen: It can tell you how many patients are part of each insurance plan. What is the percentage of [00:16:00] patients that are unrestricted right now with you? How much production are you getting? Also, it’s really important that you’re tracking the referral sources. You know, if we’re working on internal metrics for ref, for referrals, we wanna make sure that you know, 10% of those hygiene appointments.

[00:16:19] Sara Hansen: So let me give you some fun math doctors. If, let’s say you see 200 hygiene patients a month. We would hope that 10% of that, so 20 new patients the next month are coming in from. Other patients. So again, you know, there’s metrics that you can be monitoring and analyzing and growing if you utilize that practice software that you already have.

[00:16:44] Sara Hansen: So there’s a lot of great resources for teams to start looking at the data. You never want to make this transition with your practice based on emotions. You wanna make sure that that data tells that story of. Okay. Whoa. We have a [00:17:00] lot of patients that are coming in from this insurance. We know we’re writing off a lot.

[00:17:04] Sara Hansen: You know, doctors costs are going up, overhead’s going up, labs going up, and unfortunately the reimbursement rates are not going up. So again, doctors are now in this hard spot of is it time. Um, and so that’s where we wanna provide those resources for the doctor and the team and say, Hey, like, we know this is a big shift.

[00:17:25] Sara Hansen: Um, here’s what we recommend.

[00:17:27] Regan Robertson: So. So the name of the game is replacing demand before removing it.

[00:17:32] Sara Hansen: Exactly, exactly.

[00:17:34] Regan Robertson: I am, I’m so in love with the data elements of it. So the metrics that, that you should be tracking and understanding what you’re going to have to replace. Focusing on the internal. Brilliant.

[00:17:45] Regan Robertson: Obviously, uh, I mean obviously where this is what we’re always excited about. Um, let’s look over into the external pieces of this.

[00:17:52] Sara Hansen: Yeah.

[00:17:52] Regan Robertson: So, um, you know, so if you are, if you are making a pretty big shift, I can imagine, you know, that there is a lot of marketing that hasn’t been [00:18:00] looked on, you know, externally hasn’t been paid attention to as much.

[00:18:02] Regan Robertson: So what, from your perspective, what can doctors expect and what, what should be a benchmark, uh, for the external campaigns? So that, you know, it can boost up the, you know, replace the demand essentially.

[00:18:15] Sara Hansen: Yeah. Yeah. So again, if we’re tracking referral sources, that gives us really great understanding of where are our new patients coming from.

[00:18:24] Sara Hansen: So if we have, you know, 80% of our new patients a month are coming from their insurance provider because they heard about us, you know, on the directory, then we again, then we want to make that up through. Other external marketing. So, um, again, I always recommend when it comes to external marketing, you do not need to say, Hey, we’re out of network.

[00:18:47] Sara Hansen: Right? And guess what? Doctors, even if you are, you can still say, we accept and work with many insurance companies. You know, we’re happy to still. [00:19:00] Bill your insurance. As a courtesy, we’re happy to, you know, figure out what your insurance contributes towards your dental treatment, so you can still talk about those sorts of things within your external marketing.

[00:19:11] Sara Hansen: You don’t now have to remove all of that language from any external marketing pieces. Again, it’s the way that we talk about it now. Here’s where it gets a little tricky is patients will say, well, wait, you said that you bill my insurance. And the teams, they don’t understand the difference. So again, it is very important that your team understands when they’re talking to a patient, that they’re explaining to them what unrestricted means.

[00:19:37] Sara Hansen: And how it’s a patient benefit, you know? Um, we teach teams that they talk about, did you know that your insurance actually dictates what’s best for your health? And can you believe that Mrs. Jones, that someone who doesn’t even know you, has never looked inside your mouth, who doesn’t know your medical history is making decisions about you.

[00:19:57] Sara Hansen: Isn’t it great that us being an unrestricted [00:20:00]provider now we get to make that decision together? You know, so it’s conversations like that, that. We just have to teach our patients what it means because they’re so hyper-focused on, well I have to go in network ’cause that’s what my insurance says. So it’s flipping, flipping the script and really telling the patients why it’s a benefit for them to now have control over their, you know, oral health and the decisions.

[00:20:26] Sara Hansen: Like it should be a conversation between you and your doctor. And yet with dentistry we don’t treat it that way. So it’s, it’s interesting.

[00:20:37] Regan Robertson: I like that you said unrestricted. I know we have an event coming eptember called unrestricted, the end of PPE pendants and, uh, and, and marketing is going to be a big topic, so you will be at the speaker there.

[00:20:49] Regan Robertson: Can you share with our listeners a little bit about what you’ll be speaking on, uh, with that coming up in September?

[00:20:57] Sara Hansen: Yeah. You know, I think the biggest thing [00:21:00]that we want to bring to that event is how do we support the doctors and the teams, right? With this decision. So my goal with all of that is really giving away the takeaways.

[00:21:10] Sara Hansen: So when you come to that event, um. What we want for you is one, to understand how is this gonna work and what’s the strategy involved and then what are those support pieces, the tangible pieces that you can take away, take it back to your practice and say, alright, we got this, we’re gonna make this happen, and, you know, help you be successful through all of that.

[00:21:32] Sara Hansen: Um, you know, there are so many support pieces that go in with this, right? Um, making sure that even doctors have membership. Plans, um, and getting them in touch with the right companies. Um, you know, things like that. So again, anything from what can we help support you with internally and here’s the guide for that to, you know, external pieces we like to do more of, like checklist style of haes are the things that we wanna make sure that we’re [00:22:00] hitting at specific times.

[00:22:01] Sara Hansen: This is what it sounds like. So those tangible pieces are what I will be talking about. September,

[00:22:08] Regan Robertson: wait. I love that you said checklist, I believe. I think you have right now on the Phoenix website, a checklist. I,

[00:22:15] Sara Hansen: I do.

[00:22:15] Regan Robertson: Mm-hmm. Shoot. Okay. Where do they go and what is it called? Yeah.

[00:22:18] Sara Hansen: Yeah, so Phoenix. Yeah. If you go to phoenix dental agency.com.

[00:22:24] Sara Hansen: Um, it will be the first thing that pops up. It’s a free downloadable guide that, um, you can all have where again, it just walks you through what to look at, what’s first, what’s second, what things do you want to start addressing earlier rather than later? Um, why those things are important. And if, if any of that language is kind of speaking to you and you’re like.

[00:22:47] Sara Hansen: Hey, I really wanna know more. We are looking at making this shift in our practice. Um, again, that’s why we’re offering the onsite event, um, for doctors and one decision maker. So whether that’s a partner, [00:23:00] an office manager, but again, we wanna make sure that you all have the tools, that if you’re gonna make this transition, that you do it correctly and that you do it strategically.

[00:23:09] Sara Hansen: I think that’s the key. When looking at making those shifts in the practice is just doing it strategically so it makes sense and that you, you know, can replace everything that you’ve been having with something even better.

[00:23:25] Regan Robertson: Thank you Sarah and Johanna Sting. Go over to Phoenix dental agency.com. Grab that going outta network checklist.

[00:23:31] Regan Robertson: Uh, it’ll be great if you’re considering this. Congratulations. We’re excited for you as you design your new revenue mix. And, uh, I hope that these tips are helpful to you. So those that plan succeed, I know you might really wanna do it before you pull that trigger. Yeah. Uh, yeah, here’s some pieces to help educate you and prepare you.

[00:23:50] Regan Robertson: Uh, thank you. Sarah. Anything that I didn’t ask that you wanted to add?

[00:23:54] Sara Hansen: Um, no. Again, you know, doctors don’t fear this [00:24:00] transition, so again, this is about doing it the right way. If it makes sense for you, you have resources and we can help you find those resources. But, um, don’t hold back. That would, you know, that’s what we hear a lot is the doctors get really fearful.

[00:24:15] Sara Hansen: As to be expected. So doctors don’t be afraid. You know, we can help you with this or we can get you in touch with the resources that you need to help make this successful for you.

[00:24:26] Regan Robertson: Well, thank you Sarah, and yeah, doctors, good luck replacing your demand before you remove it. Hey, thanks for joining us on Everyday Practices Dental Podcast.

[00:24:35] Regan Robertson: It would mean the world to me if you could leave us a like or a review on iTunes or go to Productive Dentist Academy through Google and leave us a review there. You know, we are here each week to talk about what’s possible when you lead your practice with clarity and courage. If you are ready to build a business that supports your life and not the other way around, investment grade practice coaching powered by Productive Dentist Academy can help visit investment grade practice.com to [00:25:00]schedule your free 60 minute coaching session so you can start designing the practice and lifestyle you’ve been dreaming about all along.