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Surviving Delta Dental

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Surviving Delta Dental

Should dentists drop PPOs or play the volume game?

Every dentist has a Delta Dental story. One California doctor bought a Premier-only practice only to learn that “keeping” Premier meant signing the PPO contract. A year later, every claim defaulted to PPO fees. Not a single Premier check came through. His question­—why do we continue to let this happen?—set off a familiar chorus.

Dentists across the country describe the same squeeze. Insurance companies continue to cut reimbursements, while corporate chains happily sign every plan to fill their chairs. In saturated cities, refusing a PPO contract can feel like practice suicide. In rural towns, where one dentist might serve 3,000 people, fee-for-service still thrives. As one doctor quipped, “A $700 crown is better than an empty chair.”

The oversupply issue always arises as well. Many Townies argue that dental schools flood the market with new grads, while stagnant reimbursements make private practice owners easy prey. Some dentists have walked away from Delta completely and reported their best months ever. Others warn that the attrition is brutal. Delta can outlast a solo doc who loses 30 to 40 percent of patients overnight. As one poster joked, “If a frog had wings he wouldn’t hop.” Faith and confidence matter, but bills come due next month.

It doesn’t help that Delta’s contracts are a maze. Representatives frame it as an all-or-nothing proposition: either terminate completely or remain locked in. What they don’t emphasize is that if you go out-of-network on most PPO plans, patients still receive benefits. Claims are still being processed. Sometimes, Delta sends checks directly to patients instead of to the office, which can be frustrating but is not fatal. The exceptions are DMO or EPO plans that lack out-of-network coverage. Assignment of benefits adds another wrinkle; depending on how your office is set up, Delta may or may not send payments directly. Many dentists simply skip the hassle and collect at the time of service.

Then there are shared networks and TPAs (third party administrators). A Guardian contract might route into Aetna or MetLife. A MetLife plan may be introduced through a TPA. Insurers always look for the lowest fee schedule they can attach your name to. It feels like a game of musical chairs, except every time the music stops, your reimbursement drops. Some dentists drop a direct contract only to be picked up later at random by a TPA. Others discover that certain out-of-network payments actually beat in-network fees. The bottom line is simple: If insurers can lower your fee, they will.

This creates problems for associates, too. One dentist said 90 percent of his practice consisted of Delta patients. When he brought on an out-of-network associate, Delta started mailing checks directly to patients. Good luck chasing those down. The options were either signing the associate up for a PPO or requiring patients to pay upfront. Neither was ideal, but as one colleague put it, “Better to lose patients than to lose money.”

Buyers face their own headaches. In some states, Premier is already gone. In others, it lingers in name only, with its fees frozen or eroded until they resemble PPO rates. A practice that is heavily reliant on Delta Premier patients may appear stable on paper, but could lose value overnight if Premier disappears. Rural practices sometimes hold leverage, but metro offices with large employers have little choice. Valuations today may not match reality tomorrow.

Meanwhile, some offices experiment with workarounds. A few run dual setups, with one doctor in-network and another out. Others opt for a hybrid approach, charging in-network fees initially before transitioning patients to UCR. Some stop taking new Delta patients altogether and let the numbers shrink naturally. A few joke about shortening hygiene visits in proportion to Delta’s reimbursement. “If Delta pays 60 percent of the fee, they get 60 percent of the time.” It gets a laugh, but the frustration underneath is real.

Despite the gloom, there’s practical advice to pull from the chaos. Know your numbers. Run the math before dropping. Train your team for tough insurance conversations. Consider an in-office membership plan to keep patients loyal. If you go out-of-network, collect upfront and let patients wait for their checks. Above all, stop giving away discounts. Playing nice with insurers has never earned dentists a raise.

Humor threads through the bitterness. “Welcome to California, the Golden State,” one dentist sighed. “Delta Premier is gone with the wind.” Another called PPOs “death by a thousand cuts.” A third admitted she finally stopped caring, dropped all networks, and never looked back.

What unites these stories is the struggle for control. Insurance companies count on dentists adapting—working faster, cutting corners, and hiring associates—rather than walking away. But the dentists who do walk away often report a sense of freedom, better profitability, and less resentment in the long run. The trade-off is losing some patients, but what you gain back is control of your fees, your schedule, and your sanity.

The debate isn’t going away. Corporate dentistry continues to expand, reimbursements continue to shrink, and dental schools continue to graduate more dentists. Some see the future as a two-tiered system: corporate PPO practices for the masses and boutique out-of-network practices for those who can afford it. Others are simply trying to make it through another day in the trenches.

If Delta Dental were to vanish from your state tomorrow, would you double down on PPOs, cut your fees, or finally break free and trust your patients to follow you?

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