What PPOs are really stealing from dentists, and why you need to do something

“We all know that these third-party payers are still paying at 1960s rates. Third-party CEOs are enjoying millions per year in profit.” — Dr. Susan Dunn, Becker’s Dental Review¹

Talk to any dentist privately, and they’ll tell you what they won’t say at conferences or around their patients. They’re burned out. They’re overworked. They’re quietly angry.

Many are seriously trying to figure out how to exit PPOs, or the profession entirely. It’s no longer just about low reimbursements. It’s about the erosion of respect, the constant justifying, the gut-punch of doing $3,000 worth of work for $800 and still hearing, “My insurance doesn’t cover that.”

“It has made me hate people because they hate us first, don’t want to pay us … insurance is a nightmare.” — Dentist, Dentistry Sucks blog²

For years, PPOs have sold dentists the illusion of security. “Join our network and we’ll send you patients.” But what they really offer is a volume treadmill, one that gets faster every year while pay rates stay frozen. The truth? This isn’t a broken model. It’s a functioning one, just not for you.

“Payer reimbursements are just horrible. It’s a real disappointment and is hurting our industry.”³ — Dr. Steven Schneider, Becker’s Dental Review

What PPOs are really taking from dentists

Most of the conversations around PPOs focus on money, and they should.
The numbers are sobering:

• Reimbursements have not meaningfully changed in more than 30 years.
• Insurers rake in record profits while limiting care.⁴
• Overhead continues to rise, but fee schedules do not.⁵

But what gets less attention are the hidden costs, the ones no explanation of benefits (EOB) shows. These are the ones that slowly erode your practice, your energy, and your identity. Let’s break it down.

1. It takes a lot of dentists’ time: The administrative burden tied to PPOs is staggering. Pre-auths. Denials. Appeals. Phone calls. Downtime between low-paying patients.⁶ Also, time spent trying to explain to a patient why the care they need isn't “covered,” even though it’s clinically correct, in their best interest, and fully justified. Every one of those moments takes you away from your core skill: being a doctor.

2. It robs you of your identity: You trained to be a health-care provider, not a salesperson, not a benefits explainer, not a discount operator. When your fees are dictated by an insurance company and your clinical decisions are questioned by someone with no dental training, it chips away at your identity as a provider. Over time, it wears you down.

“Why haven’t people put down the handpieces and refused to work for half an hour for a sh*t $100 for a composite filling?”⁷ — Dentist, Reddit

3. You lose money: Yes, the fees are low. But it’s not just what you’re being paid—it’s what you’re leaving on the table. How many full-fee patients have you turned away or never attracted because your schedule is packed with PPO patients? How many treatment plans have you watered down to fit the plan, even when better care was possible? You’re not just underpaid. You’re underutilized.

4. You’re sapped of your energy: This is the silent killer. The mental and emotional exhaustion of chasing collections, managing front desk drama over denials, redoing paperwork, and delivering gold-standard care for Walmart prices. When you finish a full day of cases and your first thought is, “I can’t keep doing this,” that’s not burnout. That’s betrayal—of your talent, your training, and your time.

5. You can’t develop a good reputation: Ironically, by staying in-network, many dentists become invisible. They’re seen as a commodity, “just another name on the PPO list.” That’s not your brand. That’s their brand.

Why most dentists stay in the insurance system, even when it’s breaking them

“No idea why premiums increase yearly, yet the insurance companies play games now with preauthorizations. It’s crazy.”⁸ — Dentist, Reddit

This quote captures what many dentists are thinking: “I know it’s bad, but what else can I do?” And that’s fair. PPOs are embedded in everything—your patient base, your staff processes, your reputation, even your website copy. Pulling out of the system can feel like cutting off your own oxygen.

So, most stay. They hope next year will be better. They negotiate slightly better rates. They add a few more cases. They work through lunch. They accept the grind. All the while, the margins shrink, the tension grows, and the resentment builds—until something breaks.

“I am right now seeking legal counsel on how to escape this hell.”⁹ — Dentist, Dentistry Sucks blog

You’re not crazy for wanting out. You’re not a failure if you’re struggling. You’re just inside a system that was never designed for you to win.

A quiet, smart exit strategy from dental insurance

Here’s what many fee-for-service dentists are discovering: You don’t need to make a dramatic exit. You don’t need to blow up your practice. You just need to stop waiting for PPOs to “get better” and start building a patient flow that doesn’t depend on them. This shift starts upstream, before the patient ever walks into your office. Here’s how it works.

Step 1: Pre-educate your patients

Most dental consumers are confused. They don’t understand procedures. They don’t know the difference between providers, and they base their decisions on what their insurance covers, not what they actually need. So, they come in skeptical, price-focused, and not ready.

But when you take control of the educational process, through short videos, helpful guides, and simple visuals, everything changes. Patients arrive informed, curious, and more confident in your recommendations. This step positions you as a trusted guide, not a desperate salesperson.

Step 2: Prequalify before the consult

Every dental pro has heard, “I thought this was covered,” “I need to talk to my spouse,” “I’ll think about it.” These aren’t objections; they’re symptoms of a bad fit. Use a simple screening tool—a digital intake, quiz, or video Q&A—to filter for patients who are ready, willing, and financially able to proceed. This step saves you time and protects your team’s energy.

Step 3: Build a direct relationship with prospects

You don’t need to become a TikTok influencer. But you do need a way to stay in touch with people who’ve shown interest—email, text, short follow-up videos, drip education. Build a nurture system that builds trust over time so when they’re ready, you’re the only name they think of. This step removes your reliance on referrals and networks.

Step 4: Let your calendar reflect your value

When you build a pipeline of informed, prequalified, direct-to-you patients, something shifts. You begin to say no. You begin to charge full fees. You begin to replace low-margin PPO cases with high-trust, high-fit ones. And instead of your calendar being a source of stress, it becomes a signal of value.

What happens when dentists take control over insurance

The cost of PPO dependence is fee caps, constant selling, denied claims, patient confusion, and burnout. The value of prequalified patients is full-fee freedom, confident and educational consults, predictable cash flow, patient clarity, and sustainability.

This isn’t magic. It’s a shift in control, from the plan to the practice. From volume to value. From exhaustion to alignment. It’s not for everyone. But it is available. That reality won’t fix itself. But you can build a new one.

“We all know the unfortunate reality that dental insurance reimbursements have basically remained unchanged the last 30+ years¹⁰ (despite inflation).”¹¹ — Dentist, Reddit

More dentists than ever are quietly building their way out of the system. They’re not doing it overnight, but with strategy. If you’re one of them, you’re not just resisting PPOs; you’re rebuilding your career on your terms.

References

1. Portalatin A. Low payer reimbursements hurting dental offices, 3 dentists say. Becker’s Dental Review. October 11, 2023. Accessed June 3, 2025. https://www.beckersdental.com/featured-perspectives/low-payer-reimbursements-hurting-dental-offices-3-dentists-say

2. Dentistry Sucks. Dentistry Sucks Blog. Accessed June 3, 2025. https://bloggerdds.weebly.com/blog/dentistry-sucks

3. Portalatin A. Low payer reimbursements hurting dental offices, 3 dentists say. Becker’s Dental Review. October 11, 2023. Accessed June 3, 2025. https://www.beckersdental.com/featured-perspectives/low-payer-reimbursements-hurting-dental-offices-3-dentists-say

4. US health insurance industry posts record profits in 2023. AM Best Company. March 2024. Accessed June 3, 2025. https://news.ambest.com/newscontent.aspx?refnum=319781&altsrc=23

5. Economic outlook and emerging issues in dentistry: 2023–2024. ADA Health Policy Institute. December 2023. Accessed June 3, 2025. https://www.ada.org/resources/research/health-policy-institute/dental-statistics/economic-outlook

6. Leading dental associations call for oral health care reform to improve Medicaid access. ADA Press Release. August 16, 2024. Accessed June 3, 2025. https://www.ada.org/about/press-releases/leading-dental-associations-call-for-oral-health-care-reform-to-improve-medicaid-access

7. Comment: Why haven’t people put down the handpieces…? Reddit. r/Dentistry. Reddit user: throwawaydmdlife. 2021. Accessed June 3, 2025. https://www.reddit.com/r/Dentistry/comments/l7v7fa/why_are_dentists_so_unhappy_and_jaded/

8.. Comment: Insurance premiums go up, but…? Reddit. r/Dentistry. Reddit user: switchtosolo 2023. Accessed June 3, 2025. https://www.reddit.com/r/Dentistry/comments/13owfbt/no_idea_why_premiums_increase_yearly_yet_the/

9. Dentistry Sucks. Dentistry Sucks Blog. Accessed June 3, 2025. https://bloggerdds.weebly.com/blog/dentistry-sucks

10. Crozier S. HPI poll: Insurance reimbursement not keeping up with increased practice operating costs. ADA News. September 8, 2022. Accessed June 3, 2025. https://adanews.ada.org/ada-news/2022/september/hpi-poll-insurance-reimbursement-not-keeping-up-with-increased-practice-operating-costs/

11. Comment: Dental insurance reimbursements unchanged… Reddit. r/Dentistry. Reddit user: dmdtruth. 2022. Accessed June 3, 2025. https://www.reddit.com/r/Dentistry/comments/u5pvch/insurance_reimbursements_last_30_years/