Q1: At a high level, what does PPO Advisors do, and how did you get started?
A: Absolutely. I’m Shelley DeGroff, founder and CEO of PPO Advisors, formerly known as IDS PPO. We’ve been in business since 2013, now operating under the name PPO Advisors (ppoadvisors.com). Our mission is clear: we provide ppo solutions and ppo consulting that help dental practices turn their PPO contracts into profit. Starting as an office manager, I experienced firsthand how confusing and unfair dealing with ppo insurance companies could be. I began renegotiating contracts for my own practice—boosting our PPO reimbursements—and quickly realized this was a need many dental offices had but no one was meeting (ppoadvisors.com). That’s how PPO Advisors was born. We help practices with dental PPO negotiation, credentialing, fee analysis, and ongoing support to deliver profitable PPO outcomes.
Q2: Why do most practices outsource dental PPO negotiation rather than manage it in-house?
A: Insurance is constantly evolving—it feels like a monster that changes daily. Having one person in-house devoted only to navigating PPO complexities is unrealistic for most practices. I did it myself as an office manager and it became overwhelming alongside running treatment planning and front-office duties. Practices that outsource benefit from expert ppo consulting—allowing dental teams to focus on clinical care while we handle negotiations, credentialing, and fee schedule optimization. This model consistently delivers increased PPO profits for clients.
Q3: What happens when a dental practice engages PPO Advisors—what does the process look like?
A: It differs based on your stage:
Startups: We set your master fee schedule, guide credentialing, run zip‑code demographic analysis, and negotiate contracts before you even open.
Acquisitions: We audit existing insurance history, identify problematic contracts to term or renegotiate, and ensure clean credentialing setup.
Established practices: We analyze write‑offs, participation, shared networks, and create a strategic insurance mix using stacking methodologies while optimizing profitable PPO performance.
We work directly with your practice and communicate ongoing through the credentialing and negotiation process. We even provide 12-month EOB tracking and RISK‑FREE PPO analysis, meaning you see the projected ROI before any fees are charged (ppoadvisors.com, Podcast Episode).
Q4: Can you explain shared/umbrella network contracting and why it matters to your work in dental PPO negotiation?
A: Definitely. Shared or umbrella networks—like Connection, Carrington, Zealous or Dentimax—are third-party administrators that bundle many payers under one fee schedule. Direct contracts (e.g. Aetna, Guardian, United Concordia) may include shared agreements when you sign direct. Opting into indirect umbrella plans gives access to multiple carriers, but payers can choose not to load your provider if fees are too high. That’s why understanding stacking—ordering contracts so the highest-paying schedule is on top—is crucial to avoid most-favored-nations clauses lowering reimbursements (Blog, Maximize Reimbursement).
Q5: Why is credentialing such a crucial first step for practices, and how do you streamline it?
A: Credentialing is the gateway into PPO networks. It verifies your license, liability, NPI, etc., and can take 60–120 days per contract. Mistakes—like outdated malpractice info, incorrect address/NPI on CAQH, or mis-matched W-9—can derail the process. At PPO Advisors, we use proprietary software (CAP / CAP Plus) to streamline credentialing and proactively manage it. We also leverage credentialing as an opportunity to negotiate rate increases and avoid poor agreements that will haunt a practice long-term (CAP Plus Overview, About PPO Advisors).
Q6: What about master fee schedules—what ranges do you recommend for pediatric specialists?
A: For pediatric specialists, we target the 75th–80th percentile, sometimes higher. Anything below the 75th percentile sets your contract baseline too low and limits your ppo profits potential. A higher master fee level helps negotiation and positions your practice for stronger reimbursement across ppo insurance companies.
Q7: Some big carriers impose penalties if you move between contract types—what should practices watch for?
A: Yes. For example:
UnitedHealthcare may block you from lease affiliations indefinitely if you go direct first.
Aetna and Guardian may enforce a 12‑month out-of-network wait period before you can rejoin through indirect shared network routes.
Cigna and MetLife may default you into lower tiers if indirect rather than direct.
Knowing these clauses and planning contract strategy accordingly is critical. We always advise clients on which path gives them flexibility and long-term profit potential (See Strategy).
Q8: Is it viable to limit PPO participation to just one or two key carriers rather than signing every single one?
A: Absolutely—and in many cases, that’s smart strategy. If you’re targeting only one or two ppo insurance companies that dominate your local employer market, going direct with those while staying out of lower-value networks can yield better outcomes. When you do sign, negotiate aggressively—focus on your top-producing codes (e.g. exams, restorative), show leverage (e.g. specialty + demographic demand), and don’t accept the first reimbursement offer. ppo consulting can guide you through those conversations to get higher returns.
Q9: When does it make sense to drop or terminate PPO contracts altogether?
A: We evaluate every client’s mix annually. If certain insurers result in excessive write‑offs, create confusion via overlapping umbrella contracts, or do not produce enough volume, we recommend termination. Removing them can help stack better contracts, reduce administrative headaches, and open chair space for higher-paying patients. Even losing 50–60% of PPO patient base can maintain revenue levels if you eliminate low-paying contracts and retain higher-value ones.
Q10: How long does the entire onboarding—from master fees to effective credentialing to seeing claims come in—typically take?
A: For startups and acquisitions:
Direct contracts: effective in about 30–60 days.
Umbrella/indirect contracts: 90–120 days to activate and often another 90 days before they’re loaded across all payers—so six months or more before full in-network status across major carriers.
The sooner you engage us—especially as soon as you have a tax ID and address—the more networks you’ll be in from day one (PPO Advisors, Learn More).
Q11: What typical credentialing red flags delay or derail the process?
A: Big problems include:
Malpractice or license discrepancies not disclosed upfront.
Using a home address or mismatched SS‑4/W‑9.
Titles like cell phone numbers or wrong suite numbers that don’t match payer directories.
CAQH auto‑renewals carrying old contracts into new practices or associateships.
We catch these issues early using CAP and prevent delays by preparing accurate provider data and documentation.
Q12: Finally—what advice do you have for providers looking to improve their ppo profits and build a profitable PPO strategy?
A: Don’t rush. Take time to understand your demographics, the insurances your community uses, and how shared networks work. Start strategic—set higher master fees, negotiate smartly, avoid poor contracts, reduce overlap, and reevaluate annually. Most importantly, partner with experts in ppo consulting like PPO Advisors who can guide strategic dental PPO negotiation, protect you legally, and keep you focused on patient care—not paperwork.
✅ How to Get Started with PPO Advisors
Visit ppoadvisors.com and click “Schedule a Call” for a discovery conversation (flat-rate or acquisition model), or sign up for our Risk‑FREE PPO analysis.
Explore how CAP Plus works.
Call our office to discover how proactive ppo solutions can help turn your contracts into profits.