PPO Rates Are Frozen. Here's How to Recover the Margin.

PPO Rates Are Frozen. Here's How to Recover the Margin.

January 2025: Your Delta Dental statement shows zero rate increases. Metlife? Same. UnitedHealth? They froze fee schedules across regions, citing "market adjustments and sustainable growth partnerships."

Translation: They're tightening the screws and calling it a partnership.

PPO reimbursement for basic work (fillings, exams, cleanings) is now 15-22 percent lower than it was five years ago in real dollars when you adjust for overhead inflation. Your lab costs went up 12 percent. Supply costs up 8 percent. Salary inflation up 6-8 percent. PPO rates went up zero.

Here's your math: If PPOs make up 40 percent of your revenue, you're losing two percent of gross production annually to margin erosion.

Three plays: First, shift new patients to FFS plans. Second, batch PPO patients to hygiene-only days and associate time slots. Third, get aggressive about treatment coordination and case acceptance. If insurance won't pay, patients will. Forty percent of comprehensive cases go unproposed because dentists assume the patient can't afford it. Wrong assumption.

Stop waiting for PPOs to be fair. They're not.