The decision to drop PPO plans is one of the most significant strategic moves a dental practice can make. Yet for many dentists, fear of the unknown—particularly the threat of patient loss—becomes the barrier preventing them from moving forward. This article answers the question that stops dentists from going out-of-network: based on real-world data from hundreds of practices, what percentage of patients will you actually lose?
The Core Question: Patient Loss Expectations
When dentists contemplate dropping PPO plans, the fear is real: losing your patient base could devastate your practice. But the actual data tells a different story—one rooted in real outcomes, not speculation.
The Data-Driven Answer: When you drop PPO plans the right way, you can expect to retain 85-90% of your existing patients. This means losing approximately 10-15% of your current patient base.
This finding comes from coaching hundreds of practices through the transition to PPO independence. The number may seem surprising at first—many dentists assume they'll lose far more—but the math underlying this retention rate reveals why this transition makes financial sense.
Understanding Your Financial Reality: Insurance Write-offs
The PPO Adjustment Problem
Before we explore patient retention, it's essential to understand the financial pressure created by PPO plans. On average, PPO plans require dentists to accept a contracted fee that is 42-44% lower than their usual fees. This difference is called an "insurance adjustment" or PPO write-off.
Here's what this means in concrete terms: if your standard fee for a procedure is $1,000, a PPO patient pays only $560 (56% of your stated fee). You write off $440—money you never collect—simply to participate in that plan.
The Revenue Impact
Let's calculate what this means for your practice. Imagine you currently have 100 PPO patients, each generating $1,000 in typical annual fees:
| Scenario | Patient Count | Fee Per Patient | Total Revenue |
|---|---|---|---|
| Staying with PPO (100% PPO patients) | 100 patients | $560 | $56,000 |
| Dropping PPO (Retaining 85% at full fee) | 85 patients | $1,000 | $85,000 |
By keeping just 85% of your patients but at full fees, you generate $85,000 in revenue instead of $56,000. You serve 15% fewer patients and earn $29,000 more—while reducing your workload and stress.
Many practices see write-offs of $400,000 to $600,000 annually. To understand your specific situation, calculate your insurance adjustments. Many dentists are unaware of their true write-off burden because their practice management software shows contracted fees as the normal fee structure.
Real-World Case Study: A 12% Patient Loss
From Fear to Confidence: One Practice's Transition
Recently, a dental practice completed the full transition to PPO independence with careful preparation. Before the transition, the dentist set a goal to retain 85-90% of patients—a benchmark that initially felt unrealistic.
The Result: She lost exactly 12% of her patient base, landing squarely within the target range and on the low end of the benchmark.
What happened next was equally revealing. When reviewing the list of patients who departed, the dentist made an important discovery: of the 12% who left, only 3 patients were those she genuinely wanted to keep. The remaining 9 out of 12 departing patients were what she described as "problem patients"—those whose primary reason for coming was price-driven access through insurance, not appreciation for her clinical expertise or service.
The 88% who stayed sent a clear message by voting with their feet. Many told the dentist, "I'm not going anywhere. I love the care you provide, and I appreciate your team." These were patients who valued the practice for reasons beyond insurance eligibility.
Who Actually Leaves When You Drop PPO Plans?
The Insurance-Dependent Patient
The patients most likely to leave when you drop PPO plans are those whose primary motivation for choosing your practice was insurance coverage. These patients would be equally comfortable—or more comfortable—at any practice that accepts their insurance plan. They have no particular loyalty to you, your team, or your clinical approach.
In many cases, losing these price-sensitive, insurance-dependent patients is actually beneficial. They often demand more, appreciate less, and create operational friction without corresponding loyalty.
The Patients Who Stay
The 85-90% who remain are patients who chose your practice for its quality, your reputation, your team relationships, your technology, and your clinical approach. These patients understand that good dentistry has value and are willing to invest in their oral health directly rather than waiting for insurance coverage to dictate treatment options.
The Critical Factor: Doing It Right
The 10-15% patient loss benchmark assumes you're implementing the transition correctly. This includes:
- A readiness checklist: Ensuring your practice, team, and systems are prepared before dropping plans
- Clear communication: Giving patients advance notice and explaining the transition
- A professional transition process: Helping patients understand new payment options, financing, and the rationale for the change
- Patient identification: Knowing which patients value your practice most and prioritizing retention efforts
- Establishing value: Demonstrating why your practice is worth the investment independent of insurance
Without these elements, loss rates may be higher. But when executed strategically, the 10-15% figure is consistently validated across diverse practice types, locations, and patient demographics—from urban to rural, from corporate towns to mid-sized cities.
The Personal and Professional Benefits
Beyond the financial case, dropping PPO plans unlocks benefits that transform the practice experience:
Personal Satisfaction
When you're no longer serving insurance-dependent patients, your practice becomes a place of genuine relationships. You know your patients' names, their families, their interests, and their values. You're treating people you care about, not processing insurance claims. This transforms Monday mornings from dread to genuine excitement—from "getting through another week" to "I can't wait to see my patients."
Professional Fulfillment
Without PPO constraints, you practice the dentistry you trained to provide. You're no longer limited to the three procedures insurance will cover; you can recommend comprehensive treatment plans based on clinical need, not coverage limitations. Your professional expertise is finally your primary guide—not an insurance company's fee schedule.
Financial Security
The transition allows you to:
- Reduce overall practice debt
- Build meaningful savings and retirement plans
- Achieve compensation aligned with your expertise and effort
- Create financial stability that allows for planned growth rather than constant scrambling
Together, these elements define what we call a "thriving practice"—one that provides personal, professional, and financial satisfaction.
Beyond Patient Numbers: The Bigger Picture
While the 10-15% patient loss figure answers the surface question, it doesn't tell the complete story. Consider that many practices writing off $500,000 annually in PPO adjustments could invest a fraction of that amount in strategic marketing to attract new patients who choose them for reasons beyond insurance eligibility.
In other words, your 10-15% loss might be partially or fully offset by attracting new patients through targeted marketing to people who value quality and are willing to invest in their care. The question isn't just "How many patients will I lose?" but rather "What is my total patient acquisition and retention strategy?"
Is This the Right Decision for Your Practice?
While the data is encouraging, dropping PPO plans isn't right for every practice, at every time. Some practices need additional preparation—stronger operations, better team alignment, clearer value proposition, or stronger financial reserves. Starting before you're ready can lead to unnecessary patient loss and financial stress.
Before making this decision, evaluate your practice readiness comprehensively. An honest assessment of your current state—operations, team, finances, and patient relationships—is essential to determining not just whether you should go out-of-network, but when.
Taking the Next Step
If you've been on the fence about dropping PPO plans, you now have another data point to inform your decision. The answer to "What percentage of patients will I lose?" is encouraging—but only part of the equation.
The real question is whether your practice is ready for this transition and whether it aligns with your vision for a thriving practice. That requires a deeper conversation about your specific situation, your goals, and your readiness.
Ready to Explore Your Options?
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About the Authors
Gary Takacs
Gary Takacs is a dental practice management coach with over 40 years of experience transforming insurance-dependent practices into thriving businesses. He personally transformed his own practice, LifeSmiles, from one drowning in PPO contracts with 80% overhead into one of the top-performing practices in the US. Through his coaching program, Gary has guided over 2,200 practices through the transition to insurance independence using proven systems, strategies, and processes.
Naren Arulrajah
Naren Arulrajah is CEO of Ekwa Marketing and co-founder of RID Academy. With over a decade of experience helping dental practices attract ideal patients through digital marketing, Naren specializes in helping dentists move beyond insurance-dependent patient acquisition models. His work focuses on helping practices build sustainable, profitable patient bases of people who choose them for reasons beyond insurance coverage.
This article is based on insights from the Less Insurance Dependence Podcast and supported by real-world coaching experience with hundreds of dental practices. For more information, visit the podcast or RID Academy.
Reviewed by
Naren Arulrajah
CEO & Founder, Ekwa Marketing
Naren Arulrajah is the CEO and Founder of Ekwa Marketing, a 300-person dental marketing agency that has helped hundreds of practices grow through SEO, reputation management, and digital strategy. A published author of three books on dental marketing, contributor to Dentistry IQ, co-host of the Thriving Dentist Show and the Less Insurance Dependence Podcast, and a member of the Academy of Dental Management Consultants. He has spent 19 years focused exclusively on helping dental practices succeed online.