How to Drop a PPO

So, if I am interested in dropping PPO plans, how do I go about it? Below is a step by step approach and includes sample letters of how to make the process successful in your practice. Try it with your most frustrating PPO plan company. Then repeat it with other frustrating PPO plans.

Sign and date a termination letter. Attached is an example termination letter you are welcome to use. Submit your termination letter directly to the insurance carrier’s provider relations department. It is recommend sending it via email, mail, and fax if possible.

You will receive a response from the insurance carrier in writing to indicate your official termination date. Insurance contracts require a 60 to 90 day termination window so the response you receive from the insurance carrier will reflect the termination timeline listed in your contract.

Prepare a notification letter for your patients. Let them know that you will be terminating your contract with their insurance plan. Attached is an example letter. This letter is best given to patients in person (when they come in for treatment) so that you can make an attempt to explain the letter and let the patient know that they can continue coming to your office. For all other patients who have not been in your office during the termination window, send the letter to them 2 weeks prior to your actual termination date. If your intent is to retain those patients it’s recommended that you follow up with each patient by calling them to let them know that they can continue coming to your office for dental treatment.

On your termination date, delete the fee schedule you have on file for that insurance and begin treatment planning using your standard office fees for patients of this network.

When terminating a PPO contract, if the intent is to retain as many patients as possible it’s best to have meetings with your team to prepare them for the out of network changes. It is very common for team members to drive patients away if they are not fully prepared or fully believe that going out of network is in the best interest of the practice. When everyone believes that, it’s much easier to drop an insurance plan and retain the majority of your patients. Dear Provider Relations, Date:

I hereby tender my resignation as a participating provider of your PPO Network effective on the date of this letter. Per my contractual obligation to provide written termination notice please accept this letter as my intent to terminate my agreement with you. I request that you respond to me in writing to let me know the final date of my participation with your PPO network. I will remain active in practicing at my current location but only wish to discontinue my PPO participation. Here is our office and contact information: Doctor’s Name: Business Name: Tax ID: Address: Phone: Fax : Respectfully, Dr. ____________________________ Dear (insert patient name), I’d like to personally thank you for choosing me as your preferred provider of dental services. While I’ve been practicing dentistry for __ years I’ve invested countless hours in receiving ongoing continuing education in an effort to provide you with the best and most advanced dental treatment. Quality of Dental Care is at the forefront of my mission, vision, and values and I truly hope your experience with my team is nothing but the best. I am writing you to let you know about a change in my participation status with your insurance plan. I have elected to not participate with (enter name of insurance) as a contracted provider. However, I am pleased to inform you that you will continue to receive your insurance benefits at our practice and we will continue to process and submit all of your claims for any dental treatment we provide. My decision to discontinue participating as a contracted provider with your insurance plan was largely due to the restrictions that insurance carriers place on those that contract with insurance. Because those restrictions interfere with our mission to provide the advanced quality clinical care, changing my participation status with your insurance plan will ensure that you will receive the best care we can offer. We will have no restrictions in proving you with the type of advanced treatment we feel you deserve. We believe in excellent quality clinical care and not policy driven or restricted dental care advocated by the insurance industry. On behalf of my entire team, we look forward to continue providing dental care to you and your family and we thank you for choosing us as your dental care providers. Despite the change in our participation status with your insurance plan we will still be here to provide the high quality dental services you need, and you will continue to receive any benefits your insurance plan offers. Thank you for your time and attention and I personally look forward to seeing you during your next visit with us.

Sincerely, Dr.________________________________

Edited by Dr. Kay Christensen UDA President Elect