Navigating Dental Insurance Podcast (SayNoToPPOs.com)
Navigating Dental Insurance Podcast (SayNoToPPOs.com)
This podcast.blog teaches the best practices for cash flow, recurring revenue, Membership plans, PPO Fee negotiation, insurance best practices, marketing, reducing your dependence on dental insurance and building a fee for service practice.
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Jordon Comstock
Jordon Comstock

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We Dropped Delta: The Truth About Dropping PPOs

We Dropped Delta: The Truth About Dropping PPOs

8/14/2026 12:33:00 PM   |   Comments: 0   |   Views: 139

We Dropped Delta: The Truth About Dropping PPOs

Seven months after going fully out of network, one dental practice reveals what actually happened—the lost patients, empty hygiene chairs, membership-plan economics, and the lessons most dentists need to hear before making the jump.

By Jordon Comstock & Dr. Dan Nelson



There are certain sentences that will make a dental practice owner break into a cold sweat.

Here’s one:

“We’re dropping the PPO that represents 51% of our patient base.”

Not 5%.

Not 15%.

Fifty-one freaking percent.

That’s exactly where Dr. Dan Nelson and his practice found themselves.

Dan is a dentist, practice owner (Wood River Dental) and consultant with Elevation Association. His practice operates in an expensive resort-market economy, where payroll and the cost of doing business are high. Yet reimbursement rates haven’t necessarily kept pace with those economics.

Eventually, the math became impossible to ignore.

So his practice did what many dentists talk about doing but are terrified to actually do:

They went completely out of network.

When Dan and I recently sat down on the Automatic Patient Podcast, they were seven months into the experiment.

And I wanted to know one thing:

What actually happened?

Not the conference-stage version.

Not the consultant PowerPoint.

Not, “We dropped insurance and everything was amazing!”

I wanted the messy version.

Did patients leave?

Yep.

Did the hygiene schedule take a hit?

Absolutely.

Did they have moments where they wondered what the hell they had done?

Of course.

But something else happened, too.

Their membership patients became incredibly valuable.

Their team developed new systems.

They gained more control over pricing.

And perhaps most importantly, they discovered that leaving PPOs isn't really about dropping insurance.

It's about rebuilding the economics of the dental practice.

Here's what they learned. 

The Problem Wasn't Production. It Was Economics.

Dan's practice operates in a high-cost area.

Think Park City or Vail economics.

Housing is expensive. Employees need higher wages to live there. Payroll is expensive. Supplies have become more expensive.

But dental reimbursement doesn't magically adjust because your employees' rent went up.

Dan described working with practices in Southern California where contractual write-offs can become so aggressive that there is essentially “no meat on the bone.”

That's the trap.

A practice can look busy.

Production can look great.

Patients can be everywhere.

But if the underlying unit economics deteriorate, volume doesn't necessarily fix the problem.

Sometimes volume actually amplifies it.

This is becoming increasingly important as practices deal with rising expenses.

Dan told me he's seen major increases in payroll in recent years, particularly around hygiene, along with meaningful increases in supply costs.

He gave me one extreme example from Southern California.

A longtime hygienist entered what was essentially a bidding war for his labor.

The eventual wage?

Around $90–$95 an hour.

I joked:
“Is the doctor cheaper than that now?”
We laughed.

But it's not particularly funny when you're the owner writing the checks.

At some point, you have to ask:

If my labor costs, supplies and overhead keep increasing, but my reimbursements don't keep pace, what happens to my margin?

There's only so much efficiency you can squeeze out of a practice.

Eventually, the business model itself has to change. 

The Superpower of Going Out of Network: Control

Dan brought up something I think gets overlooked in the PPO conversation.

Pricing control.

When you're out of network, you can look at your P&L and make intelligent adjustments.

Maybe you don't need a dramatic 10% fee increase.

Maybe a high-volume code needs to go up $5.

Maybe another needs to increase $2.

Those tiny changes across thousands of procedures can matter.

But here's the important part:

You can make the decision.

Dan recommends first understanding the prevailing fees in your local market, then comparing those against your actual overhead and economics.

If your costs have risen significantly, the old rule of simply raising fees a couple of percentage points annually may no longer be sufficient.

And there's an important lesson even for practices that remain in network:

Don't stop increasing your UCR fees just because you're writing off the difference.

As Dan pointed out, if dentists throughout a market fail to adjust their submitted fees as their economics change, insurers have less market evidence pushing reimbursement upward.

So don't look at the adjustment and say:

"What's the point?"

There is a point.

Know your numbers.

Know your market.

And know what it actually costs you to deliver dentistry.

Then Came the Scary Part

Let's get to what everyone really wants to know.

What happened to the patients?

Before leaving Delta, approximately 51% of Dan's patient base was associated with Delta plans.

His practice had roughly 3,000 patients.

That's a big exposure.

They didn't simply wake up one Tuesday morning and say:

"YOLO. Let's drop Delta."

They prepared.

And one of the smartest things they did was break their insurance population down further.

Because “Delta” isn't really one homogeneous group.

Different employers can have different plan designs and different out-of-network benefits.

Dan's team analyzed patients by employer and tried to understand which groups were most vulnerable.

Some plans had surprisingly reasonable out-of-network benefits.

Others?

Not so much.

That allowed the team to begin estimating which patients would likely stay and which would probably leave.

And Dan's advice here is important:

Prepare for the worst.

Don't build your financial model around the assumption that everybody loves you so much they'll happily pay whatever happens after you leave the network.

Some won't.

That's reality.

Build the Safety Net BEFORE You Jump

This might be the biggest lesson from our entire conversation.

Dan's practice didn't start building its membership program after leaving Delta.

They built it beforehand.

For years, they had been developing what they call their patient benefit plan.

As the PPO exit approached, they pushed it harder.

They marketed it.

They put it prominently on their website.

They talked about it on social media.

They put information throughout the office.

And most importantly:

Their team talked about it.

The assistant talked about it.

The hygienist talked about it.

The front desk talked about it.

The financial coordinator talked about it.

The treatment coordinator talked about it.

The patient couldn't turn a corner without being reminded that there was another option.

And this matched something I've personally seen.

I've literally sat inside successful dental practices for hours watching their patient flow.

Yes, I'm that boring.

I'll bring lunch, sit in the waiting room and watch.

And the practices that crush their membership-plan growth almost always have one thing in common:

Membership isn't a marketing campaign. It's part of the culture.

The hygienist mentions it.

The assistant mentions it.

The doctor reinforces it.

The front desk explains it.

Then the patient sees information about it throughout the office.

You can't just put a “Membership Plan” button on your website and expect 500 people to magically join.

The real conversion happens through human relationships.

Dan put it perfectly:
“No patient that is either uninsured or is on a self plan… should leave our office without a pamphlet in their hands.”
That repetition matters. 

Then They Got Punched in the Face

There's a Mike Tyson quote Dan referenced:
“Everyone has a plan until they get punched in the face.”
That's basically the PPO-exit experience.

You can prepare.

You can model.

You can train.

You can communicate.

Then reality arrives.

For Dan's practice, one of the biggest punches came through hygiene capacity.

Before the transition, their hygiene department normally operated around 90% capacity.

During roughly the first six months after the exit?

Dan said it was around 75% capacity.

That's painful.

And here's the really painful part:

You still have to pay your hygienists.

Dan explained that patient loss doesn't necessarily happen all at once.

There can be waves.

Wave One: “I'm leaving.”

These patients hear that you're going out of network and immediately decide to find an in-network dentist.

Strangely enough, these can be easier operationally.

You know they're leaving.

Their future appointment disappears.

You can begin filling it.

Wave Two: “I'll give it a try.”

These patients love the practice.

They love the dentist.

They love the team.

They think:

"We'll make it work."

Then they experience the financial reality of being out of network.

Six months later, they may decide they can't continue.

Now another hole appears in the hygiene schedule.

Wave Three: The Silent Cancellation

This is the nasty one.

The patient schedules.

Everyone thinks they're staying.

Then a week before the appointment—or the day before—they get cold feet.

Cancel.

Now you've got an empty chair and very little time to fill it.

That's why a PPO exit isn't simply a financial strategy.

It's an operational strategy.

Their Response Wasn't Panic. It Was a System.

This part of Dan's story fascinated me.

After leaving the PPO, his team started seeing holes in hygiene.

Dan would ask his leadership team:

"What are we doing about recare?"

The answer?

“We're working through the lists.”

Dan hated that answer.

And I totally understand why.

What does working through the lists mean?

How many people?

How many contacts?

How many responses?

How many appointments?

Where are patients getting stuck?

So Dan took his background in psychology and communication and began creating an actual process.

His team determined that text messaging was their most effective communication channel for this workflow.

Then they built an algorithm.

An active patient who had visited within their chosen window but wasn't scheduled for hygiene could enter the system.

The team sends a specific text.

No response?

Another communication follows.

Still nothing?

Another.

After three unsuccessful attempts, the patient gets moved into a dormant group for approximately 90 days rather than consuming endless staff time.

If the patient responds, the workflow changes based on that response.

Now Dan can see what's happening.

Not:

“We're working on it.”

But:

We contacted X patients.

Y responded.

Z scheduled.

These patients didn't respond.

These patients enter the next workflow.

That's management.

And according to Dan, the system has helped them bring patients back and fill holes created during the transition. 

Then Dan Dropped the Number That Should Make Every Dentist Pay Attention

During our conversation, I asked Dan about something I obsess over:

Annual patient value.

Forget vanity metrics for a second.

How much economic value does each type of patient actually create?

Dan's answer surprised even me.

In his practice:

Their patient-benefit-plan members were worth approximately two times what a Delta patient was worth.

And according to Dan, they were worth approximately 3X more than a cash patient.

That deserves another read.

The membership patient wasn't simply a consolation prize for losing PPO patients.

In Dan's practice, the membership patient was economically more valuable.

Now, that's one practice's experience—not a universal industry benchmark. Every dentist should calculate the numbers in their own practice.

But Dan has seen similar patterns elsewhere.

He told me a hilarious story about being on a fishing trip in Alaska with a couple of dentists.

One dentist basically told him:

"There's no way."

No way membership patients could be worth that much more.

Another dentist on the trip texted his office manager while they were fishing.

They checked.

Sure enough, his membership patients were worth more than double.

The skeptic later checked his own data.

About a week later, he texted Dan:

“All right, you're right.”

Then came the inevitable next question:

"Tell me more about this. How do I start one?"

The Costco Effect Comes to Dentistry

Why might this happen?

Dan and I started talking about what I call the Costco effect.

You know exactly what I'm talking about.

I go to Costco telling myself:

"I'm buying steaks and potatoes."

That's it.

Steak.

Potatoes.

Then somehow I leave $400 poorer.

Steak.

Potatoes.

A TV.

A water-gun set.

Maybe a PlayStation 5.

Apparently I needed 600 light bulbs.

What happened?!

Part of the psychology of membership models is that the relationship changes once someone belongs.

Companies like Costco and Amazon have built enormous businesses around membership relationships.

That doesn't mean your dental practice should become “Netflix for teeth.”

Please don't put that on your building.

The point is that membership changes the economic relationship between customer and business.

And in dentistry, there's another benefit.

The patient isn't primarily attached to an insurance network.

They're attached directly to your practice.

That distinction becomes incredibly important when you're trying to reduce PPO dependence.

Dentistry Doesn't Need to Go Cold Turkey

I want to be very clear about this.

Neither Dan nor I is suggesting every dentist reading this article should walk into the office tomorrow and terminate every PPO contract.

That's reckless.

Dan himself warned against it.

Some practices have the financial reserves and overhead structure to make an aggressive transition.

Most should prepare.

So I think the smarter framework is:

Build the financial safety net first.

Build the membership plan.

Train the team.

Analyze your patient base.

Analyze each employer group.

Understand out-of-network benefits.

Know which patients are most likely to leave.

Build cash reserves.

Create your recare system.

Track annual patient value.

Rank your PPOs.

Then begin making strategic decisions.

You don't have to go from 100% PPO-dependent to fee-for-service overnight.

You can build your way out.

BoomCloud: Build the Alternative Before You Need It

This is one of the reasons we built BoomCloud.

BoomCloud helps practices create, manage and automate their own dental membership plans.

Instead of waiting until the PPO economics become unbearable, practices can begin creating a direct recurring-revenue relationship with patients today.

Create your plans.

Enroll patients.

Automate recurring payments.

Manage renewals.

Track membership revenue.

Get your entire team involved.

Then grow the program.

The goal isn't merely to sell another dental product.

It's to create optionality.

Because a dentist with zero membership revenue and enormous PPO dependence has fewer options.

A dentist with hundreds—or thousands—of patients paying the practice directly every month is playing a very different game.

The Real Lesson From Dan's Experiment

Seven months after going completely out of network, Dan didn't tell me it was effortless.

I'm glad he didn't.

I'd be suspicious if he had.

There were patient losses.

There were holes in hygiene.

There were difficult conversations.

There were moments of fear.

They had to develop new systems.

They had to respond to problems they couldn't perfectly predict.

But they also opened another office.

They brought in an associate.

They continued moving forward.

And now they have something they didn't have before:

Control.

Control over pricing.

Control over patient relationships.

Control over their business model.

And a growing base of membership patients who, in their own data, are considerably more valuable than the PPO patients they were afraid to lose.

Dan's final advice was perhaps the most important:

Don't do this alone.

Talk to dentists who've already done it.

Learn from their mistakes.

Find a consultant who understands the transition.

Study the economics.

Build systems.

Because eventually, something will go wrong.

The hygiene schedule will develop holes.

A patient group will react differently than expected.

You'll get punched in the face.

The goal isn't to create a plan that guarantees you'll never get punched.

The goal is to know how you're going to counterpunch.

That's the lesson.

Maybe the future of dentistry isn't about figuring out how to see more and more patients at lower and lower reimbursement rates.

Maybe it's about building a smaller number of more valuable, more loyal, more direct patient relationships.

Maybe the question isn't:

“How do I survive another PPO fee schedule?”

Maybe it's:

“How much of my practice do I actually control?”

Because Dan's practice just put 51% of its patient base on the line to find out.

And seven months later?

They're still standing.

Actually, they're building.

And that might be the most important part of the story.
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