FFSA INSIGHTS
Will I Lose Patients
If I Drop My PPOs?
This is the question that keeps dentists up at night. You've run the numbers, you know your PPO write-offs are eating 25–35% of production, and some part of you already knows the plans have to go. But then the fear shows up: if I drop insurance, do my patients walk out the door?
It's a fair fear. And the honest answer is: yes, you will lose some. Not all. Not most. Some. The dentists who get burned are the ones who either pretend the number is zero, or panic and assume it's everyone. The truth lives in the middle, and once you understand where, the decision gets a lot less scary.
The Number Nobody Wants to Say Out Loud
Let’s put the honest ceiling on the table first. In practices that leave PPO networks the right way, attrition tops out around 30%, and in most cases it comes in well below that. That is the worst-case planning number, not the expected one. If you build your transition assuming you’ll lose about a third and you lose far less, you’ve planned like an adult and you sleep fine along the way.
Here’s the part that reframes the whole question. When patients in these practices were asked why they chose their office, only about 6–7% pointed to insurance as the reason. Six or seven out of a hundred. The other ninety-plus stayed for the dentist, the team, the trust, the results. So the real question isn’t “will I lose patients”, it’s “am I willing to lose the small slice who were only ever here for a network logo, in exchange for a practice that finally pays you for your work?”
Who Actually Leaves, And Why That’s Fine
The patients most likely to leave are the ones who were shopping on price the whole time. They picked you off a directory. They’d pick someone else off a directory tomorrow. You were never really their dentist; you were their in-network option.
There’s a cautionary tale worth remembering here. One practice that handled a transition badly went from around 1,200 active patients down to under 300. That number gets passed around as proof that dropping insurance is suicide. It’s actually proof of the opposite: it’s what happens when you change too much at once, communicate poorly, and give patients no bridge to stay. Done that way, of course people leave. Done correctly, that collapse simply doesn’t happen — and the practices that plan for a 30% ceiling routinely beat it.
The One Rule That Protects Your Patient Base
If you take one thing from this article, take this: change one thing at a time.
The dentists who lose 300 patients try to do everything on the same Monday — drop every plan, raise every fee, restructure the schedule. Their patients feel the ground move all at once and bolt. The dentists who keep their patients drop plans in sequence, give patients a clear path to stay, and let the practice absorb each change before making the next.
That path to stay is usually a membership plan — an in-house option that gives your uninsured and soon-to-be-out-of-network patients a reason to remain. Benchmarks that work look like roughly $30–35 a month for an adult, around $22 for a senior, and about $80 for a family. It’s not a magic wand, but it’s the bridge that turns “I guess I’ll find someone in-network” into “okay, I’ll stay with Dr. So-and-So.”
A Word About Delta Dental
If you’re contracted with Delta, read your agreement carefully before you do anything, and get help reading it. Assignment of benefits provisions can quietly change how — and whether — your out-of-network patients get reimbursed, and that detail can swing how many of them stay. This is exactly the kind of landmine that’s invisible until you step on it. It’s not a reason to avoid the transition. It’s a reason not to do it alone.
This Isn’t For Everyone
Some practices shouldn’t drop their PPOs — at least not yet. If you’re brand new, if your schedule is empty, if you have no relationship capital built with your patients, dropping insurance is the wrong first move. Fee-for-service is a destination you earn your way to, not a switch you flip on day one. Be honest with yourself about where you are.
And be honest about the timeline. A real transition takes time — often somewhere between 12 and 48 months depending on where you’re starting. Anyone promising you an overnight flip, or promising you a specific income number, is selling you something. This is a rebuild, not a light switch.
So, Will You Lose Patients?
Yes. A few. Mostly the ones who were never really yours. If you plan for a 30% ceiling, change one thing at a time, and give the rest a bridge to stay, you'll almost certainly keep far more than you fear — and the practice you're left with pays you for your dentistry instead of an insurance company's discount schedule.
The patients worth keeping are the ones who'd follow you anyway. Those are the ones this move is built to protect.