Let’s talk about something that keeps dental practice owners up at night: insurance negotiations. You didn’t go into dentistry to become an expert in fee schedules and reimbursement rates. But managing PPO strategy and participation has become a massive part of your job anyway.
Here’s the reality: if you’re like most practice owners, you’re leaving significant revenue on the table without even realizing it. Most dentists have no idea what they’re actually being paid compared to what they could be paid. Insurance companies are counting on that.
The “Set It and Forget It” Trap
Most practices handle PPO negotiations the same way: sign up early, maybe negotiate a rate or two in the beginning, and then: nothing.
Years go by. Fee schedules stay frozen. Overhead climbs. New plans enter the market. Old plans change their terms. And your practice just keeps accepting whatever comes its way.
That approach isn’t just passive. It’s expensive.
Insurance Companies Aren’t Your Friends
Let’s be blunt: insurance companies don’t lead with their best offer. They lead with what they think you’ll accept. And most practice owners accept whatever lands on their desk because they don’t have the time or the stomach for a fight.
We get it. But that reluctance is costing you real money.
This Isn’t Just About Higher Fees
Sure, getting paid more per procedure matters. But a smart PPO participation strategy goes deeper. It’s about alignment between:
- The plans you accept and the patients you want
- Your fee schedules and your actual overhead
- Your participation decisions and your growth goals
A high-complexity restorative practice needs a different strategy than a high-volume hygiene practice. A DSO needs a different approach than a solo practitioner.
Here’s another truth that ruffles feathers: not every insurance plan deserves a spot in your practice. Some plans will never pay you fairly, no matter how hard you negotiate. The smartest move sometimes is walking away.
What Smart Strategy Looks Like
Start with your numbers. Not just your current rates, but how they compare to what’s possible in your market. We regularly see practices that have been underpaid for years simply because they never knew better rates were available.
From there, prioritize. Which payers are worth cultivating? Which ones will never make sense? And yes, that means having hard conversations. When an insurance rep says “that’s the best we can do”, it’s almost never true. It’s just the best they’ll offer until someone pushes back.
Why Experience Matters
Insurance companies are professionals at negotiation. It’s literally their job to minimize payouts. You have a practice to run. Patients to see. Staff to manage.
Walking into that imbalance rarely ends well.
At Five Lakes, we’ve been doing this since 2010. We’ve negotiated thousands of contracts across all 50 states. We know which payers bend and which ones don’t.
Our clients don’t come to us to save a few bucks. They come because they’re tired of leaving money on the table and want someone who actually knows what they’re doing.
Our Process
We start by taking a fresh look at your current participation. We’re not assuming everything needs to change. But we are always looking at what’s possible.
For some practices, that means renegotiating their top five plans. And for others, a complete refresh: dropping bad plans, adding good ones, optimizing everything.
For DSOs acquiring practices, it means having a clear insurance transition plan. Nothing kills patient retention like insurance confusion after an ownership change.
Improve Your Bottom Line Today
You’ve built something valuable. You deserve to be paid fairly for it. But fair compensation doesn’t just happen. It requires strategy, expertise, and someone willing to advocate for you. The practices that thrive aren’t the ones hoping insurance companies play fair. They’re the ones who take control of their PPO strategy and refuse to settle for less.
That’s what we do at Five Lakes. If you’re curious whether your current strategy is leaving money on the table, we should talk. Contact us to schedule an initial consultation and let’s explore how you could get more from your insurance contracts.