# Which PPO Should You Drop First? A Ranking Framework

> A scoring framework for ranking every PPO you're in on write-off %, patient count, admin friction and growth potential, so you know which one to drop first.

- Author: Ryan Smith, DDS
- Published: 2026-06-09
- Category: Practice Management & Profitability
- Canonical: https://ryansmithdds.com/which-ppo-to-drop-first

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> **Key takeaways**
> - Drop your lowest-volume plan first, as a rehearsal, not your worst-paying one.
> - Twenty percent of your plans are usually causing eighty percent of the pain. Find them before you touch anything else.
> - Score every plan on write-off percentage, patient count, admin friction, and growth potential. The write-off number alone can point you at the wrong plan.
> - There are legitimate reasons to stay in a bad plan longer. Know them before someone talks you into leaving too fast.

"Which one first?" is the question that stalls more owners than "should I do this at all?" Once you have run the numbers in [how to read your write-off report](/ppo-write-off-analysis), you usually have three or four plans that all look bad. Staring at all of them at once is how a practice ends up doing nothing for another year.

I have watched a dentist drop two major plans at once, without training the team first, and have to backtrack within months. I have also watched offices drop their lowest-paying plan, lose a manageable slice of that plan's patients, and come out ahead within six months. In another office, three plans came out over the course of a year and profit was up roughly 30% by the end of it. The difference was never courage. It was sequencing.

This article assumes you have already done the arithmetic. You know each plan's write-off percentage and its lost revenue per year. What it does not tell you is the order to act in, because the plan costing you the most money is not always the plan you should touch first.

## Start with the low-volume plan, on purpose

Pick your smallest, lowest-impact plan first, even if it is not your worst discount. The goal of the first drop is not maximum savings. It is teaching your team the entire process (the letters, the front-desk script, the claims-as-a-courtesy conversation) while the stakes are small enough that a mistake does not sink a quarter.

Say one of your plans covers ninety patients and discounts you 28%. That is not your ugliest number. It is your best rehearsal. Get good at the transition on ninety patients (the letters go out, the front desk fields the same three questions, claims still get filed as a courtesy), and your team will run the same playbook on your five-hundred-patient plan without you standing over their shoulder.

## Twenty percent of your plans are usually causing eighty percent of the pain

Once you are past a handful of plans, this pattern shows up almost every time: two or three contracts account for most of the write-off dollars, most of the denials, or both. The rest of your panel is mediocre, not actively hostile. Find the two or three first.

Ryan cites ADA survey data showing roughly one in three dentists dropped a network in 2025, which is worth knowing mainly because it means you are not early to this and you are not doing anything unusual by handling it in stages instead of walking out on everyone at once.

## Score every plan on four dimensions, not just the discount

The write-off percentage from your production report is the loudest number, but it is not the only one that matters. Score every plan you are in on these four:

| Plan | Write-off % | Patient count | Admin friction | Growth potential | Read on it |
|---|---|---|---|---|---|
| Plan D (leased network) | 28% | Low (90) | Low | None | Small and simple: your rehearsal |
| Plan C | 41% | Low (150) | High | None | Worst discount, small enough to move on soon |
| Plan B | 36% | Medium (500) | Medium | Low | Biggest dollar loss, real patient base: plan it, don't rush it |
| Plan A | 22% | High (900) | Low | Medium | Smallest discount, most patients, still growing you: stays for now |

*Illustrative example, continuing the four plans from [how to read your write-off report](/ppo-write-off-analysis).*

- **Write-off %:** the number this whole cluster starts with. Run it through the [PPO drop calculator](/tools/ppo-drop-calculator) once you have it, since break-even patient loss is identical to this percentage.
- **Patient count:** not automatically bad if it's high, but it sets how much marketing and front-desk bandwidth the transition needs. A five-hundred-patient plan is a project; a ninety-patient plan is an afternoon.
- **Admin friction:** denials, eligibility headaches, and, especially with leased or umbrella networks, the finger-pointing between the carrier and the network when a payment does not match your contract. See [auditing your EOBs](/dental-insurance-underpayment) for what that friction actually looks like from the inside.
- **Growth potential:** whether the plan is still sending you real new patients, and whether those patients convert into the kind of case acceptance that [grows a practice](/double-dental-case-acceptance) rather than just filling a chair for a cleaning.

Notice that Plan B tops the dollar ranking in the write-off article, but it is not first on this list. It has real patients and moderate friction, which means the transition needs planning, not urgency. Plan D and Plan C, smaller and messier, move first.

I do not use a weighted formula to turn these four columns into a single number, and I would be suspicious of anyone who tells you they have one that actually works across different practices. What I do instead is read the table left to right and ask which plan is smallest and simplest. That goes first. Then which plan is causing the most staff time and complaints regardless of its dollar rank. That goes next. The plans with real patient volume and real growth potential go last, however bad their discount looks, because leaving them requires more preparation, not more courage.

## The phased exit, spelled out

The [original stay-or-go breakdown](/how-to-drop-dental-ppos) lays out the big picture. Here is the phased version I actually use, plan by plan:

*The phased exit. Five stages, not a cliff.*

1. **Join plans to fill your chairs.** As a new practice, take the volume. This phase is about survival, not optimization.
2. **Drop the worst payers first, once you're at capacity.** This is the 20/80 phase: the plans you scored lowest above.
3. **Negotiate better fees with the rest.** A polite, data-backed ask can buy you time with a plan you are not ready to drop yet; see [how to ask a PPO for a fee increase](/ppo-fee-schedule-negotiation).
4. **Simplify with umbrella networks where the terms are genuinely better.** Fewer contracts, one fee schedule to track, but verify who you are actually credentialed with; see [leased networks and credentialing](/leased-ppo-networks-and-credentialing).
5. **Go fully independent** once your reputation, recall system, and new-patient flow are strong enough to carry the practice without a network behind it.

Most practices live in phases two and three for years. That is not failure. That is the plan working at the pace your cash flow and your team can handle.

## Four reasons to stay in a plan longer than you'd like

Dropping plans is not a race, and there are real reasons to hold a bad contract longer than the spreadsheet says you should:

- **You're a startup.** You have not built the patient base that would let you replace a plan's volume yet, and a new practice needs the chairs full more than it needs the fee schedule optimized.
- **Your patient experience isn't consistently five-star.** Insurance is the safety net that catches inconsistency. If the reviews, the recall system, and the case acceptance are not there yet, fix the experience before you remove the net.
- **You're in a low-income area where nearly everyone depends on insurance.** The math changes when the realistic alternative for a patient is delaying care, not paying cash. Read the community, not just the spreadsheet.
- **Your cash reserves are thin.** A transition that goes sideways for two or three months should not be able to threaten payroll. Build the buffer before you take the risk, not after.

None of these are permanent conditions. They are reasons to sequence the exit later, not reasons to abandon it.

## Do this Monday

- Pull the scoring table from your own panel: write-off %, patient count, admin friction, growth potential, one row per plan.
- Circle your smallest, lowest-stakes plan. That is your rehearsal, not your worst payer.
- Run its write-off % through the [PPO drop calculator](/tools/ppo-drop-calculator) to confirm the break-even math before you announce anything.
- Identify the two or three plans doing most of the damage (write-off dollars, denials, or both), and put them on a real timeline.
- Write down which of the four reasons to stay applies to any plan you are tempted to leave in place, so it's a decision and not just inertia.