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Written by Shelley DeGroff, Founder & CEO of PPO Advisors

Last Updated: September 5, 2026

Dropping PPO plans is the wrong first move for most dental practices. The right first move is knowing your break-even retention number for every contract you hold.

This applies to any insurance-based practice thinking about going out of network. Across more than 4,000 dental practices, PPO Advisors, a PPO negotiation and credentialing company for dental practices, has seen the same pattern: the plans dentists want to drop are often the plans that just need to be renegotiated.

There is an order to this work. You negotiate first. You measure second. Only then do you ask whether a contract is worth keeping at all. This post walks through the numbers that decide when dropping PPO plans pays off.

Prefer to watch? The full discussion on dropping PPO plans and the break-even math is here:

What Is Break-Even Retention for a Dental Practice?

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Break-even retention is the percentage of patients a dental practice must keep at full fee for leaving a PPO network to produce the same collections. The math is simple: divide what you collect from that plan today by what the same production would bring at your full fee.

PPO write-offs are the difference between your full fee and the contracted rate the insurance company allows. If a carrier writes off 30% of your fees, you collect 70 cents on the dollar. Keep 70% of that carrier’s patients at full fee after leaving, and your collections stay flat. Keep more than 70%, and everything above that line is upside.

Carrier Write-Off Rate	Break-Even Retention	Patients You Must Keep (per 100)
20%	80%	80
30%	70%	70
40%	60%	60
45%	55%	55

The lower the write-off, the harder it is to justify leaving. The higher the write-off, the more room a practice has to lose some patients and still come out ahead. That percentage anchors every honest conversation about dropping PPO plans.

Margin makes this even sharper. The latest data puts average practice overhead between 71% and 76%. Overhead in a dental practice is largely fixed, so a cut in reimbursement does not shave the same percentage off your profit. It takes a much bigger bite. That same math runs in reverse when the discount is removed.

 

Why Should You Negotiate Before Dropping PPO Plans?

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Negotiating before dropping PPO plans can take the exit decision off the table entirely, because a better fee schedule raises the bar a network must clear to be worth leaving. A plan that looks like dead weight at its current rates can become one of your better contracts after renegotiation.

In one PPO Advisors fee negotiation analysis, a practice held nine network contracts. Six of the nine improved. One national carrier moved from 56% to 70% of the practice’s full fee, worth about $21,000 per year on the same production, the same patients, and the same schedule. The six increases together added roughly $50,000 per year. Nobody had to drop anything.

Negotiation also changes the break-even math. Raise a plan from 56% to 70% of full fee, and its break-even retention rises from about 56% to 70%. You would now need to keep 7 of every 10 patients to justify leaving instead of roughly 5.5. The better the contract pays, the harder leaving is to justify.

Three networks in that same analysis were marked “stay” with no renegotiation attempted, because they already paid near the ceiling of any available schedule. That is the point of measuring first: some contracts need a raise, some need to be left alone, and only what remains belongs in the conversation about dropping PPO plans.

 

Which Numbers Should You Track Before Dropping PPO Plans?

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Track four numbers by payer, not as a practice-wide average: write-off percentage, collection rate, denial rate, and days in accounts receivable. Most practices measure production. Production tells you how busy you are. These four numbers tell you which insurance contracts are eating your margin.

Averages hide the problem. A practice-wide write-off of 35% could mean every plan writes off 35%, or it could mean two plans write off 15% while two others write off 55%. Those are very different drop lists.

These numbers do two separate jobs. Before you negotiate, they tell you which contracts to take back to the table. After you negotiate, they tell you which contracts still do not work. That shorter second list is the real out-of-network conversation, and it is much shorter than the list most dentists start with before dropping PPO plans.

Nationally, PPO write-offs now average 42% to 45% of billed fees. Run the calculation on your own production before trusting any industry average.

 

How Do You Read an Out-of-Network Analysis?

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An out-of-network analysis ranks every carrier by how easy it is to leave, using your practice’s own production data instead of industry averages. PPO Advisors runs this break-even summary as a second phase of its PPO analysis for established practices, after negotiation has already fixed what can be fixed. It is the last checkpoint before dropping PPO plans turns from an idea into a plan.

Here is what one row looks like in practice. A carrier brought 79 patients and $152,000 of production at full fee, but the practice collected only $85,000 under the contract. Keep 44 of those 79 patients at full fee, and collections stay flat. Every retained patient above 44 is profit the contract was taking.

Each carrier then gets its own page, modeling full-fee collections at 80%, 60%, and 40% patient retention against what the practice collects today. The owner stops guessing and starts reading their own numbers. The analysis does not predict what will happen. It shows what would have to happen for the decision to work.

One more caution: the carrier in that 79-patient example was the same carrier that moved from 56% to 70% in the negotiation described earlier. For that practice, the right answer was not to leave. It was to get paid properly first. Interest in leaving networks is growing, which makes it more important, not less, to run the numbers before acting.

 

How Do You Leave a PPO Network Without Losing Half Your Patients?

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Leave one network at a time, worst plan first, with each drop capped at about 15% of practice revenue and a patient safety net live before anyone hears a word. Practices that succeed at dropping PPO plans treat it as a sequenced project measured in months, not a decision executed by Monday.

Three things make an exit work:

• Your own break-even number. Not an industry average, not a number from a Facebook group. The percentage of patients your practice must keep, calculated from your production.
• A sequenced exit. Rank the contracts that survived negotiation from worst to best. Drop the worst one first. Never everything at once, and never more than about 15% of revenue in a single drop.
• A live safety net. This is the step most practices skip. An in-office membership plan, patient scripts, and a trained team must all be in place months before patients hear anything about the change.

The safety net matters because retention is the whole ballgame. One membership plan software company that co-presents with PPO Advisors estimates practices that leave a network with no membership plan keep about 40% to 60% of those patients, while practices with an established plan keep about 60% to 80%. On the break-even table above, that gap is the difference between a losing exit and a winning one.

State rules also differ on what leaving a network requires. Leased and shared network arrangements can keep paying you at a discounted rate even after you think you have left one contract, which is why exit work belongs in the same engagement as the contract analysis. The ADA’s Health Policy Institute tracks dental benefit participation trends if you want the broader industry picture, but your decision about dropping PPO plans should rest on your own PPO contract data.

 

The Bottom Line

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• Never drop a PPO plan before trying to renegotiate it; a raised fee schedule can take the exit decision off the table entirely.
• Break-even retention equals collections today divided by full-fee production; at a 30% write-off, a practice must keep 70% of that carrier’s patients to break even after leaving.
• A million-dollar practice with a 35% average write-off gives up roughly $350,000 per year to insurance adjustments.
• Dropping PPO plans works as a sequenced exit: worst plan first, each drop capped at about 15% of revenue, never everything at once.
• The safety net, including a membership plan and patient scripts, must be live before patients hear a word about dropping PPO plans.

 

Frequently Asked Questions About Dropping PPO Plans

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How many patients do I need to keep if I drop a PPO plan?

The number of patients a dental practice must keep after dropping a PPO plan equals collections from that plan today divided by what the same production would bring at full fee. At a 30% write-off, that means keeping about 70% of the plan’s patients to break even. Every patient retained above that percentage is where dropping PPO plans turns profitable.

 

Should I negotiate my PPO fees or drop the plan first?

Negotiate first, always. Renegotiating a PPO fee schedule can turn a plan you wanted to drop into one of your better contracts, and PPO Advisors sees an average 20% fee increase after renegotiation. Only the contracts that will not move, or whose ceiling is still too low, belong in the drop conversation.

 

Is dropping PPO plans worth it for my dental practice?

Dropping PPO plans is worth it only when your own break-even math says so for a specific contract. If the write-off is high, the plan will not renegotiate, and your realistic patient retention beats the break-even percentage, leaving can add significant profit. If any of those three conditions fails, staying in and getting paid properly is usually the better move.

 

Can I drop all my PPO plans at once?

No, dropping PPO plans all at once puts too much revenue at risk at the same time. A safer exit removes one network at a time, worst plan first, with each drop capped at about 15% of practice revenue and several months of preparation before each one. Learning from the first exit makes every following exit smoother.

 

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✍️ Shelley DeGroff
Founder, PPO Advisors