Phase 1 · Days 1–3
The Audit
See the full financial truth of every PPO plan in your practice — for the first time.
Pull Your PPO Data from Your PMS
Export your Production by Insurance Carrier report from your practice management software. Set the date range to the most recent 6 or 12 months — longer periods smooth out seasonality. Export the report as a CSV file and save it to your computer. You'll upload it in Step 2.
Dentrix (Server / G-series)
Reports → Management → Practice Analysis → Production Summary by Insurance Carrier. Set the date range, run the report, then File → Export → CSV. Some older versions: Reports → Ledger → Insurance Carrier Production Report.
Dentrix Ascend / Cloud
Reports → Production & Income → Production by Insurance. Set the date range in the top-right, then click the Export button (icon top-right of the report). Choose CSV.
Eaglesoft
Reports → Practice → Insurance Production Analysis. Set your date range, click Run, then Export → CSV (or Excel). Some practices use the alternate path: Reports → Insurance Analysis → Production by Insurance Carrier.
Open Dental
Reports → Monthly → Production & Income → Insurance Breakdown. Or use Reports → Standard → Procedures by Insurance Plan. Set the date range, run, then File → Export to CSV.
Curve / tab32 / Other
Search your Reports menu for "insurance production", "production by carrier", or "insurance analysis". The report you need shows production and collections grouped by insurance plan. If you can't find it, contact your PMS support — every modern PMS has this report. You can also enter your plans manually in Step 2 without uploading a CSV.
My production and collections numbers look very different. Which do I use?
The report you want shows both — gross production at UCR (your full fees) AND actual collections. The gap between them is the write-off, which is exactly what the audit measures. Don't worry about picking the right column manually; the audit tool will detect both automatically from your CSV.
How many months of data should I pull?
12 months is ideal — it smooths out seasonality and gives the most accurate picture. 6 months is fine if your data is messy or your PMS export is slow. 3 months will work but the audit will be more volatile. The audit tool annualizes whatever period you pull, so you don't have to do that math.
Can't find the report? Book a 15-min support call → and we'll walk through it together.
Run Your Audit
Open the audit tool below. You'll walk through three quick stages: (1) your practice overhead and a few assumptions, (2) upload the CSV from Step 1 (or enter plans manually), and (3) review your full per-plan profitability breakdown with Keep / Negotiate / Drop classifications and projected annual upside. Your progress auto-saves, so you can pause and resume any time.
I don't know my exact overhead numbers. Can I estimate?
Yes — pull your last 3 months of P&L statements and use monthly averages. The audit is sensitive to overhead accuracy, but ballpark numbers give you a usable picture. Once you see your initial results, you can refine the numbers with your bookkeeper or CPA. The worst thing you can do is stall on this step trying to get perfect numbers.
Should I include doctor compensation in overhead?
Yes — the audit has dedicated fields for this. Put your own W-2 salary (or a reasonable market-rate equivalent if you only take distributions — typically $150k–$250k per year, divided by 12) in the Owner Compensation field. Put any associate doctor salaries in Associate Compensation, or leave it at $0 if you're solo. An audit that treats the owner as if they work for free produces unrealistically rosy results.
How accurate does "Total Active Patients" need to be?
Fairly accurate — this number drives how overhead gets allocated across plans. Two things: (1) Include BOTH your PPO patients and your fee-for-service / uninsured patients. If you only enter PPO patients, your overhead gets concentrated entirely onto PPO plans and everything looks worse than reality. (2) "Active" means seen in the last 12–18 months, not every record in your PMS. Most practices land between 1,200 and 2,500 active patients.
My CSV import says "Could not detect a header row" or "Could not find required columns."
Usually means the PMS export has metadata (report title, date range, account name) above the actual data table. Open your CSV in Excel or Google Sheets and delete any rows above the column headers (Carrier / Production / Collections), then save and re-upload. Or use the "Other / Generic CSV" option in the PMS picker — the generic parser is more flexible. If all else fails, just type your 5–8 plans manually below the upload zone (takes about 5 minutes).
My CSV imported but I still need to add patient counts per plan. Why?
PMS production reports typically don't include patient counts — they show financial totals only. After importing, you'll need to add the active patient count for each plan manually (this is a separate number from your PMS). Most PMS systems have a separate "Patients by Insurance" or "Active Patients" report; pull that to get the counts. The audit can't allocate overhead correctly without patient counts.
What do KEEP, NEGOTIATE, NEGOTIATE HARD, and DROP mean?
KEEP = net margin is above your target. Leave it alone. NEGOTIATE = profitable but below target; a fee increase fixes it. NEGOTIATE HARD = unprofitable BUT too many patients (≥10%) to safely drop. You have to fight for a fee increase. DROP = unprofitable AND low patient volume — safe to terminate. The distinction between NEGOTIATE HARD and DROP is the critical one: both are losing money, but the risk of walking away is completely different.
Need help running the audit? Book a 1:1 review →
Procedure Deep Dive (per plan)
For any plan you're going to negotiate, click Deep Dive on its row in the audit results and enter your top 5–15 CDT codes with your UCR fees, the PPO's allowed fees, and your annual volume. The tool calculates exactly how much each procedure is costing you — this is the ammunition you'll attach to your negotiation letter. You can do this for just the plans you're negotiating; you don't need to fill it in for plans you're keeping or dropping.
Why do I need procedure-level data for negotiations?
Negotiations work when you bring receipts. A letter that says "your fees are too low" gets ignored. A letter that says "your fees on D2740 are $980 versus my UCR of $1,500 — that's a 35% reduction across 85 crowns a year, costing my practice $44,200 in revenue annually" gets attention. The procedure deep dive produces those exact numbers for every code you choose to highlight.
Which CDT codes should I include?
Focus on your highest-volume, highest-revenue codes — usually 10–15 codes generate 80% of your production. Standard ones to include: D0120 (periodic exam), D1110 (adult prophy), D2392 (composite 2-surf), D2391 (composite 1-surf), D2740 (porcelain crown), D2750 (porcelain-fused crown), D2950 (core buildup), D3220 (pulpotomy), D7140 (extraction), D4910 (periodontal maintenance). If you do a lot of one specialty (perio, endo, cosmetic), include those too.
Where do I find the PPO's allowed fee?
It should be in your fee schedule from the carrier. If you don't have it handy, you can pull a recent EOB for that procedure code under that plan — the "allowed amount" column is what the carrier paid (often equal to allowed fee if there's no patient portion). You can also call the carrier's provider relations line and request a current fee schedule.
My UCR fees are higher than what I actually charge. Which should I use?
Use your actual UCR — the fee you'd charge an uninsured cash patient. That's the comparison the carrier expects in a negotiation: "this is the gap between what I'd otherwise charge and what you're paying me." If your UCR feels high, that's normal — UCR is usually 15–25% above what insurance pays. Don't lowball yourself just because you've been accepting the PPO rate for years.
Need help building your negotiation packet? Book a 1:1 →
Phase 2 · Days 3–30
Negotiation
Secure a 10–25% fee increase on any plan worth saving — or confirm it needs to be dropped.
Prepare Your Negotiation Package
Open the negotiation builder. Pick the plan you're negotiating and everything pre-fills from your audit — practice details, carrier name, plan name, patient count, annual production, and your top CDT codes from the Deep Dive. Fill in only what we can't auto-detect (provider ID, carrier fax, years in network), adjust the requested fee % (default 20% above allowed), and the letter renders ready to send.
What should I set as my "requested fee" for each CDT code?
Aim for 15–30% above the current allowed fee, not your full UCR. If the carrier pays $850 for a crown now, request $1,050–$1,100. Requesting your full UCR ($1,500) will be rejected outright; requesting a moderate increase is much more likely to be accepted or counter-offered. The goal is a realistic ask they can say yes to.
Where do I find my "practice value" data (patients, annual production volume)?
These are your negotiation leverage points. Pull: (1) total patients actively seen on this carrier's plan in the last 12 months, (2) total production you generated for this carrier's patients last year at UCR fees, and (3) years you've been in-network. Carriers care about provider value — a practice that generates $200k/year in volume for them is worth retaining, and they know it.
Should I mail, email, or fax the letter?
Fax is still the gold standard for fee schedule review requests — carriers are structurally set up to process fax submissions, and they create a paper trail. Email to Provider Relations also works if the carrier publishes an email address. Regular mail is slowest and most likely to get lost. Use fax if at all possible; services like HelloFax or SRFax let you send from your computer without a physical fax machine.
Still stuck? Book a 1:1 with our team →
Submit and Follow Up
Call the carrier's Provider Relations line to confirm the submission process (fax preferred). Send your package. The negotiation builder includes a submission tracker — log your send date, status, and the auto-calculated 15-day and 30-day follow-up dates. If no adequate response by day 30, this plan moves to Drop — don't negotiate indefinitely.
The carrier hasn't responded in 3 weeks. Did I do something wrong?
No — silence is normal. Most carriers take 4–8 weeks to process fee schedule review requests. Week 3 is too early to worry. Follow up with a polite call to Provider Relations at the 30-day mark, ask for a case or reference number, and note the rep's name. If there's still no response by day 45, it's time to escalate.
They offered me a 3% increase. Is that worth accepting?
Almost certainly not. A 3% fee increase is essentially inflation — it doesn't meaningfully move the math. Counter with: "I appreciate the offer, but to keep this plan profitable for our practice we'd need at least X%" (where X is whatever makes your audit spreadsheet show a positive margin). If they hold firm at 3%, this plan moves to the Drop path.
They countered with 12%. The audit showed I needed 18%. What do I do?
This is the most common real-world outcome. Run the 12% through your audit spreadsheet — some plans turn profitable at lower increases than you'd expect because of volume effects. If 12% gets you to a positive margin (even if smaller than ideal), accept it. If 12% still shows a loss, counter once more at 16%, and if they reject, terminate.
Still stuck? Book a 1:1 with our team →
Phase 3 · Days 3–14
Membership Launch
Build the membership plan that gives your patients somewhere to land before you terminate anything.
Design Your Plan & Model Enrollment
Open the membership calculator. In the Plan Design section, set monthly pricing for each tier (start with $35 adult, $45 perio, $25 child), enter your actual cost to deliver each included service, and set your treatment discount at 15% — aim for at least 40% gross margin per member. Then scroll down to Enrollment Assumptions; the calculator pre-fills your patient count and write-off rate from your audit. Adjust retention rate, join rate, and churn, then review the 12-month forecast and PPO replacement analysis. The breakeven callout tells you exactly how many members you need to fully replace the dropped revenue.
Why $35 for adult membership and not $25 or $45?
$35 is the national sweet spot — high enough to produce meaningful MRR, low enough that 30–50% of non-insured patients will say yes. Go lower and your margin compresses; go higher and conversion drops sharply. You can adjust after launch based on your local market (high-cost-of-living areas can support $39–$45; rural markets might need $29–$32). Start at $35, measure, adjust in 90 days.
What should I include in the base membership?
Standard inclusion: 2 cleanings/year (D1110), 2 exams (D0120 or D0150), routine x-rays (D0274 bitewings annually, D0210 FMX every 3 years), and emergency exams. Include fluoride for kids. Don't include anything that has high variable cost (like ortho or implants) — those should be discounted, not included.
What if my costs to deliver the included services are higher than the monthly fee?
If your per-member cost exceeds revenue, you've got a pricing problem. Check: (1) are you allocating marginal cost (the extra cost of treating one more patient) or fully loaded cost (including overhead)? For members, use marginal cost — the membership is filling capacity that would otherwise be empty. (2) Is your visit assumption realistic? Most members only use 1.6 visits per year, not 2. If you recalculate with these and you're still losing money per member, raise your price.
My projections show I need 200 members to replace the dropped plan. That feels impossible.
The first 20–50 members are the hardest. After that, word of mouth and internal referrals kick in and growth accelerates. A practice that enrolls 5 members in its first week typically hits 100 members by month 6 and 200 by month 12. The math isn't linear — it's compounding. Also remember: you don't need to replace 100% of the dropped revenue on day one. If you replace 30% in the first 90 days, the plan termination is still net profitable.
What retention rate should I use? I don't know how many patients will stay.
Default assumption: 75% retention when you have the communication scripts and a membership alternative ready. Use 60% if you're not doing proactive outreach, 85% if you have a very relationship-heavy patient base. Err slightly conservative — projected numbers that turn out better than expected are easier to defend than the reverse.
Still stuck? Book a 1:1 with our team →
Launch Your Membership Plan
Scroll to Launch Materials in the membership calculator and print the two ready-made documents: a one-page patient handout (for the front desk and exam rooms) and a four-scenario enrollment script (for your front desk and hygienists). Both auto-fill from your tier pricing. Then choose your payment processor — Stripe or Square for under 50 members, Kleer or BoomCloud for larger or compliance-sensitive setups — and begin enrolling, prioritizing patients from any terminated plans first.
Stripe, Square, BoomCloud, or Kleer — which should I actually use?
Under 50 members and just getting started: Stripe or Square. Cheap, simple, you handle billing manually through your existing systems. 50–500 members: Kleer or BoomCloud. These are dental-specific membership platforms that handle member enrollment, recurring billing, family plans, and reporting. Kleer is simpler; BoomCloud has more features. 500+ members: BoomCloud is usually the right fit. Most practices start with Stripe and migrate to Kleer/BoomCloud around month 6–9 as volume grows.
My state has specific rules about dental membership plans. How do I know if I'm compliant?
Dental membership plan regulations vary significantly by state. 13+ states require specific disclosures, filings, or compliance structures. Before launch, check with a dental-focused attorney (not a general practice attorney) or use Kleer/BoomCloud — both handle state compliance as part of their platform. If you're using Stripe/Square directly, you're responsible for compliance research. At minimum, your member agreement must clearly state that this is not insurance.
My front desk doesn't know how to talk to patients about membership. What do I do?
Enrollment is a skill that improves with practice. Print the four-scenario enrollment script from the Launch Materials section of the membership calculator and run a 30–60 minute team role-play before going live. Key principles: (1) only offer membership to patients who would benefit — never pressure, (2) lead with savings compared to out-of-pocket, (3) make signup easy (one form, one payment method, done). Offer a bonus to front desk staff for the first 20 members enrolled — $10–$20 per signup is a fair motivator.
Still stuck? Book a 1:1 with our team →
Phase 4 · Days 14–60
Termination & Patient Retention
Exit unprofitable plans cleanly and keep 70–90% of affected patients.
Prepare Before Sending Anything
Open the termination builder. Pick the plan you're terminating and the audit data pre-fills automatically — practice info, carrier name, patient count, annual loss. You'll add the contract notice period (60/90/120 days from your provider agreement) and the system computes the effective date, the patient letter mail date, and the day-by-day timeline. Critically: have your membership plan ready before patients hear about the change.
My provider agreement is long and full of legalese. What am I looking for?
Search the document for the word "termination" — it's usually a labeled section. You need three things: (1) required notice period (typically 60, 90, or 120 days), (2) whether notice must be by certified mail or a specific method, (3) any auto-renewal clauses that require notice by a specific calendar date. Take a photo of this section and note the key dates in your Key Dates Tracker before doing anything else.
I can't find my original provider agreement. What do I do?
Contact the carrier's Provider Relations and request a copy of your current contract — they're required to provide it. This takes 1–2 weeks to receive. In the meantime, assume the longest common termination window (120 days) so you don't accidentally terminate incorrectly. Once you have the agreement, you can adjust your timeline.
Should I set up my membership plan before or after I send the termination notice?
Before, always. This is the single most important rule of PPO terminations: never tell a patient you're dropping their plan without having a concrete alternative to offer them. The membership plan is that alternative. Phase 3 (Steps 6–7) — membership — should be complete BEFORE you start the termination prep here so that by the time the first patient letter goes out, you can say "and here's what we've built for you instead."
Still stuck? Book a 1:1 with our team →
Send the Termination Notice
In the termination builder, print Document 1 (the carrier notice) signed by the owner-doctor. Mail via certified mail, return receipt requested. The submission checklist marks each milestone — sent / team briefed / patient list exported / patient letters mailed — so you can track progress across multiple plans you're terminating at once.
Do I really need to send the termination notice by certified mail?
Yes, if your contract requires it (most do). Certified mail with return receipt creates legal proof of delivery and the date. This matters if the carrier ever claims they didn't receive it, or disputes the effective date. The cost is ~$10. Don't skip this — it's the single most important piece of termination documentation.
My office manager wants to send the letter instead of me. Is that okay?
The letter should be signed by the owner-doctor, not the office manager. Carriers treat termination notices from non-owners differently and may reject them. Your office manager can prepare the letter and mail it, but the signature and the return address should be the owner's.
When exactly does my termination go into effect?
Effective date = date carrier receives the letter + notice period required by contract. For example: certified mail delivered March 15 + 90-day notice = June 13 effective date. Enter this exact date in your Key Dates Tracker and work backward from it to schedule patient letters (30 days before effective date) and team briefings (before any patient communication goes out).
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Launch Patient Communication
In the termination builder, print Document 2 (the patient letter) and personalize it with each patient's name — your PMS bulk-letter feature or Word's mail merge handles this in a few minutes. Mail 30 days before the effective date. Print Document 3 (seven front-desk phone scripts) and tape them at the front desk station. Make proactive calls to your top 20–30 patients before their letters arrive.
My front desk is nervous about the patient calls. They don't want to upset people.
This is extremely common. What works: (1) do a 30-minute role-play session where you play both the patient and the front desk, using the exact phone script, (2) let them hear you handle a difficult call first, (3) reassure them that the scripts work — 70–90% of patients stay when communication is handled well, (4) remind them that nobody is losing their job over patient losses. Front desk anxiety is usually about fear of being blamed, not fear of the conversation itself.
A patient is threatening to leave a bad Google review.
First: don't respond in anger, don't offer bribes to remove it, don't argue. Use the "Handling Upset Patients" section of the Patient Communication document. If they do leave a negative review, respond publicly with a calm, professional acknowledgment — prospective patients reading reviews trust how a practice handles criticism more than whether criticism exists. One negative review among many positive ones barely moves the needle. Most threatened reviews never actually get posted.
What do I do about patients who are mid-treatment when the termination hits?
For patients with in-flight treatment (crowns in lab, ortho in progress, planned perio maintenance), honor the original fee schedule for that treatment plan through completion. Carriers generally allow "grandfathering" of in-progress treatment for 30–90 days after termination. Document each case in writing. This is a small financial hit but it's the right thing to do and prevents most complaints.
My team is more resistant than I expected. What if they just refuse to follow the scripts?
This is actually a bigger issue than most people realize — and it has less to do with the scripts and more to do with whether your team trusts the decision. Before handing out scripts, hold a full-team meeting and explain the "why" with real numbers. Show them the audit. Explain the membership plan. Make them co-owners of the decision, not order-takers. If resistance continues after that, it's a deeper management issue worth a 1:1 to work through.
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Ongoing · Repeat Quarterly
Monitor & Measure
Track your actual results, prove the ROI, and pick your next target plan.
30-Day Check-In
How many patients from the dropped plan have been seen since the change? How many stayed vs. left? How many joined the membership? What's your current MRR? Compare your actual retention rate and enrollment numbers against what you estimated.
My retention is lower than the spreadsheet projected. What went wrong?
Three most common causes, in order: (1) communication was rushed or delegated without proper training — patients felt informed, not cared for, (2) the membership plan wasn't positioned clearly as the alternative, so patients defaulted to shopping for new dentists, (3) the PPO decision was communicated before the membership plan was ready, creating a gap in the patient experience. If retention is more than 15% below projection, book a 1:1 to audit your communication approach.
Still stuck? Book a 1:1 with our team →
90-Day Full Re-Audit
Re-export your PMS data for the most recent period. Update the audit spreadsheet with new numbers. Calculate your actual profit improvement — reduced write-offs + fee increases + new membership revenue. That's the ROI number. Then pick your next target plan and repeat Phases 2–4.
When should I do my next audit cycle?
Every 90 days, minimum. PPO fee schedules drift (usually downward), your overhead shifts, and your patient mix evolves. A practice that audits quarterly catches new profit leaks before they compound. Set a recurring calendar reminder for the first Monday of each quarter: "Run the PPO audit." It's a 30-minute quarterly habit that compounds into huge ROI over 2–3 years.
My first action didn't produce the expected result. Should I still pick another plan?
Yes, but diagnose first. Understanding why the first action underperformed — carrier rejected negotiation? Retention was lower than projected? Membership uptake slow? — tells you which adjustments to make for the next plan. Don't just repeat the same process on a new plan and hope for different results. Book a 1:1 if you want help diagnosing.
Still stuck? Book a 1:1 with our team →
Stuck on a step? Get help from our team.
Unlimited 1:1 screen share sessions, whenever you need them. Most owners barely use them — the software handles the heavy lifting — but when you want a second opinion before a big decision, book a session.