31.8% of Dentists Are Dropping PPOs. Here's the Playbook.

31.8% of dentists are actively planning to leave PPO networks. That's not a fringe movement - it's nearly one in three.

Here's why the math stopped working.

The Write-Off Problem

The average PPO write-off is 42-45%. On a $1,200 crown, you're collecting $660-$696. Your lab bill alone is $96-$150. Your overhead on that procedure is roughly $500. You're making $160 on a procedure that took an hour of your clinical time.

Across a full year, practices with heavy PPO participation lose $350K+ in write-offs on $1M in production.

The Hygienist Math That Broke PPOs

This is the number that changed everything: your hygienist costs $45-60/hr. A PPO adult prophy (D1110) reimburses $50-70.

Read that again. You're paying your hygienist nearly the same amount the PPO pays for the entire cleaning. After supplies, overhead allocation, and front desk time, you're losing money on every PPO hygiene visit.

Post-pandemic hygienist wages jumped 30-40%. PPO reimbursement rates haven't moved in 30 years. That gap is now a canyon.

The DOC Access Act

The DOC Access Act (passed as part of recent federal legislation) is designed to increase transparency in dental insurance. Key provisions:

• Requires insurance companies to maintain an 85% medical loss ratio (85 cents of every premium dollar goes to actual dental care)
• Bans retroactive claim denials beyond 12 months
• Requires network adequacy reporting

This is a step in the right direction, but it won't fix your write-off problem today. If you're waiting for legislation to save your margins, you'll be waiting a long time.

The practices making moves now are the ones that'll come out ahead. Here's how they're doing it.

Sources: ADA Health Policy Institute surveys, ADA HPI PPO participation data, DOC Access Act provisions