Let’s start with a truth every dentist knows: modern dental insurance is a joke. It’s a broken system that should, at best, be called a “discount plan.”
Consider this: the annual maximum benefit for most dental plans has been stuck between $1,000 and $2,000 since the 1970s—nearly 60 years ago. Factoring for inflation, which has accelerated dramatically in recent years, those maximums should be closer to $15,000 today.
While patient benefits have remained stagnant, the allowable fees paid to dentists have been relentlessly squeezed, falling further and further behind the real cost of running a practice.
Insurance companies have tried to turn our highly skilled procedures into commodities, creating a frustrating and demoralizing race to the bottom. So, what can we do? Assuming the government isn’t going to overhaul the system, we have three realistic options.
Option 1: Drop Insurance Entirely (The High-Risk, High-Reward Path)
This is the dream for many, but it’s a dangerous path if you’re not prepared. Most PPO-driven practices are built to be clinically focused, not marketing-focused.
If you simply drop all plans without a strategy, you can expect to lose 20-30% of your patients almost overnight. Your higher fees might boost profits initially, but without a powerful marketing engine to replace patient attrition, your practice will likely shrink over time.
To succeed as an out-of-network practice, you must transform into a marketing-driven machine:
- Budget: Consistently spend ~10% of your revenue on marketing.
- Brand: Your practice must be highly marketable, with impeccable customer service.
- Content: You need an active online presence filled with videos, social proof, and valuable content.
If you’re willing to make that fundamental shift, dropping insurance can be incredibly successful. If not, it’s a gamble that rarely pays off.
Option 2: Play the Volume Game (And Win?)
The second option is to accept the system and try to beat it at its own game. This means becoming a high-volume, high-efficiency practice.
You focus on decreasing costs, increasing your speed, running more chairs, and handling more exams simultaneously. This model can be profitable, but it requires a complete commitment to a volume-focused workflow. If you try to provide a fee-for-service experience on a PPO reimbursement schedule, you will struggle financially. It’s a choice, but for many, it’s not a fulfilling one.
Watch the full breakdown of the problem and the path forward.
Option 3: The Two-Tier System (Your Most Realistic Way Out)
This is the most powerful and realistic strategy for most PPO-driven dentists. The insurance companies want to treat your work like a commodity, so let them—but only for the service their fee actually covers.
The solution is to create two tiers of service in your practice.
You are not just offering a crown; you are offering two distinct types of crowns. You give the patient a choice:
- The Insurance-Level Crown ($800): A solid, basic restoration that meets the standard of care. It’s made in an inexpensive, reliable lab and may take 2-3 weeks to return. This is the service that the PPO fee fairly compensates you for.
- The Premium Digital Crown ($1,400): A superior restoration using the latest technology. It might be a same-day CEREC crown, made with premium materials, or fabricated by a high-end local lab known for its artistry.
This isn’t just about crowns. It applies to cleanings (a basic prophy vs. an hour-long appointment with advanced tools), fillings, and nearly every procedure you offer.
Reclaiming Your Clinical Freedom
We became dentists to do great work. The constant pressure from insurance to cut corners and use cheaper materials is demoralizing. The two-tier system breaks this cycle.
Insurance companies may try to intimidate you with contract clauses suggesting you must offer the same service to everyone. That is ridiculous. If a patient is presented with two distinct options and chooses to pay more for a premium product or experience, no insurance contract can legally prevent that.
An $800 PPO fee does not and should not entitle a patient to a $1,400 same-day crown. By creating clear, separate tiers, you are no longer being “manipulated”—you are offering transparent choices.
This strategy allows you to:
- Remain in-network for patients who need that basic level of care.
- Increase profitability by offering premium services to patients who value them.
- Invest in new technology like scanners and mills, knowing you have a way to be compensated for them.
- Work with the best labs for patients who choose that option.
- Restore your excitement and passion for clinical excellence.
Start small. Pick one procedure this month and define your two tiers. Train your team on how to present the options. This isn’t just a financial strategy; it’s a way to take back control and make dentistry fun and fulfilling again.
