The Fee That Patients Are Most Sensitive To When You Resign From Their PPO Plan

When a practice drops a PPO plan, patients don’t always react the way you’d expect. It’s not the cost of a crown or an implant that surprises them—it’s their hygiene visit. For years, they’ve believed their cleanings were “free,” but once you’re out of network, that changes.

In this episode, Gary and Naren dive into why hygiene visit fees create the biggest pushback, how insurance companies handle co-pays differently, and what you can do to keep patients from leaving. You’ll hear real-world examples, simple communication strategies, and ways to prevent surprises for your patients.

Navigating this transition doesn’t have to be difficult. By preparing in advance and understanding what matters most to patients, you can avoid common pitfalls and ensure a smoother shift to fee-for-service.

If you’re thinking about resigning from PPOs, this episode is a must-listen. Learn how to keep your practice thriving while reducing insurance dependence—without losing valuable patients.

Key Takeaways

1. Hygiene visits are the biggest concern when dropping a PPO. Patients don’t usually complain about the cost of crowns or implants, but they notice when their “free” cleaning suddenly has a fee.
2. Co-pays can vary widely. Some patients might pay nothing, while others could see a charge as high as $240. Knowing how different insurance plans handle out-of-network cleanings helps you prepare.
3. Clear communication can keep patients from leaving. Explaining the value of your care and why their costs have changed makes a big difference in patient retention.
4. Marketing is key to a smooth transition. If some patients leave, strong marketing will help you replace them with new patients who choose you for quality, not just because of insurance.

• 00:00:07 – Welcome & Introduction
  • Gary and Naren introduce the episode and explain why this topic is critical for dentists looking to reduce insurance dependence.
  • Announcement of an upcoming event on April 9th about building strong patient relationships.
• 00:02:08 – The Fee That Patients Notice Most
  • The one fee that causes the biggest reaction when resigning from a PPO: the adult hygiene visit.
  • Why patients perceive hygiene visits as “free” and how that changes when you go out of network.
• 00:03:45 – Why Patients React Strongly to Hygiene Fees
  • The psychology behind why a $50 hygiene fee feels bigger than a $1,000 crown cost.
  • A real-life story about a patient who compared dental fees to trading chickens—highlighting how people perceive costs differently.
• 00:06:14 – How Co-Pays Change After Leaving a PPO
  • The wide range of co-pay costs: some patients pay nothing, while others may owe up to $240.
  • Why group policies and employers play a huge role in determining out-of-network costs.
• 00:10:40 – What to Say When Patients Ask About Pricing
  • The importance of knowing your patients’ co-pays before they ask.
  • How to frame the conversation: “Many patients choose to stay because they value the care and experience we provide.”
• 00:12:44 – Strategies to Prepare Before Dropping a PPO
  • Scheduling strategy: Book patients for their next cleaning in advance while gathering co-pay details.
  • Using EOBs and pre-determinations to get accurate insurance estimates.
• 00:15:20 – Marketing Your Practice to Attract the Right Patients
  • How focusing on patients without insurance can eliminate these issues altogether.
  • The growing trend of freelancers and gig workers who don’t rely on PPOs and are looking for quality care.
• 00:18:05 – Final Thoughts & Next Steps
  • How dentists can prepare for a successful transition away from PPOs without losing revenue.

Some patients are fine paying thousands for a crown, but a $50 hygiene co-pay makes them hesitate. It’s not about the money—it’s about what they expect to pay.

When patients ask about pricing, you need to be ready with an answer. ‘I don’t know’ isn’t good enough. Knowing their co-pays before they ask makes all the difference in keeping them in your practice.