PPO participation can quietly erode profitability when fees, network relationships, and write-offs are not regularly reviewed. In this episode, Kirk Behrendt talks with Clinton Johnson, founder of Profitable PPOs, about the hidden PPO mistakes that can cost dental practices seven figures over time. Clinton explains how PPO network structures work, why reimbursement has failed to keep pace with rising practice costs, how to evaluate the true financial impact of each plan, and why dentists should build a PPO strategy around their practice goals rather than making emotional decisions.
Learn how to audit PPO participation, identify low-profit plans, improve reimbursement, and strategically move toward greater profitability and autonomy — listen to Episode 1094 of The Best Practices Show!
Main Takeaways:
- PPO reimbursement has not kept pace with inflation and rising practice expenses, forcing many dentists to work harder to maintain previous income levels.
- Dentists can participate in PPOs through direct contracts, network share agreements, or umbrella companies, and those options can produce significantly different reimbursement levels.
- A PPO strategy should be designed around the practice’s priorities, including profitability, broad network coverage, and administrative simplicity.
- PPO write-off percentages can be misleading when a practice’s office fees are not appropriately set for its geographic market.
- Dentists should review EOBs and conduct a comprehensive PPO audit approximately every 18 to 24 months to verify network participation, fee schedules, and opportunities for improvement.
- Practices considering PPO reductions should use financial data and generally begin with smaller plans that have poor reimbursement rather than making large changes based on frustration.
- PPO optimization should include analysis, strategy development, financial modeling, implementation, and verification that insurers are paying the expected fees.
Episode Chapters:
00:00 Introduction to hidden PPO mistakes that can cost a practice seven figures.
01:11 Kirk introduces Clinton Johnson and the complexity of PPO participation.
03:57 Why dentists are producing more without necessarily becoming more profitable.
05:58 Three ways dentists can participate in PPO networks.
09:51 Why PPO write-off percentages can be misleading.
12:08 Clinton explains the PPO profit ladder.
13:41 The long-term financial and practice-value impact of poor PPO reimbursement.
16:16 Why dentists need to monitor EOBs and identify missed upside opportunities.
21:03 How to evaluate which PPOs are helping or hurting the practice.
24:55 Why traditional PPO fee negotiation is less effective than it once was.
27:09 When dentists should stay in a PPO or consider leaving.
30:00 Risks of leaving a PPO without a structured plan.
31:41 How PPO strategy can support independent dentistry.
34:21 Which practices are and are not a good fit for PPO optimization.
37:28 Clinton explains the Profitable PPOs analysis and strategy process.
41:30 How to contact Profitable PPOs.
42:00 Closing thoughts on profitability, independence, and practice ownership.
Guest Bio:
Possessing over twenty years of experience working with dental offices, Clint Johnson is passionate about helping practice owners optimize their PPO plan participation and profits. As the founder of Phoenix-based Profitable PPOs, Clint has focused that passion by helping ensure dentists participate with the right PPOs, in the right way, and for maximum reimbursement. Hundreds of dental practices every year, across the United States, big and small, look to Profitable PPO to provide the insurance participation management needed to make the most of their profitability–both in the present and in years to come.
For Clint, dentistry has always been a family matter, with his father, grandfather and great-grandfather all dentists. The experience of seeing both the benefits, and the challenges, in dentistry inspired him to help doctors optimize their practices. Clint knew there had to be a way to help those in the dental field deal with the challenges and costs associated with insurance participation… And that challenge was the impetus behind the creation of Profitable PPOs.
In addition to his work with Profitable PPOs, Clint is also an author and a frequent presenter at dental conferences. In his free time, he enjoys reading, skiing, scuba diving, and traveling with his wife and three children.
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