Do Dentists Really Have to Stay Trapped by PPOs?

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Intro: You are now listening to another episode of the Insurance Untangled podcast, where we explore the various challenges faced by dental practices due to their reliance on insurance. Join us in this podcast as we dive deep into the issues surrounding dental insurance dependence and offer practical solutions and strategies to help you take control of your practice’s financial future.

Naren Arulrajah: Welcome to another exciting episode of the Insurance Untangled podcast. I’m Naren Arulrajah, one of the, of this podcast dedicated to helping practices that are tangled up with insurance. We talk about topics that help you take more control and create a bigger and better future for you, your patients, and of course, your team members. Today my guest is Ben, my dear friend, and we will be talking about a really important topic. And that topic is, do dentists really have to stay trapped by PPOs? Do dentists really have to stay trapped by PPOs? Ben, thank you for joining us. Before we jump in, can you take a minute and tell us what you have been up to lately? Yeah.

Ben Tuinei: Naren, thank you for, uh, the introduction there and, uh, yeah, so super excited about today’s episode. You know, I think this is a really important episode. You know, when we talk about, uh, the whole concept of PPOs, and especially now, you know, we’re—this is being recorded in the thick of a government shutdown here in the United States. Yes. And it, and it’s a pain point because why? There’s nervousness among consumers that’s trickling into the dental offices, where fee-for-service practices have been contacting me to see if they should go back in network. But PPO practices that want to go out of network are feeling trapped. So today’s episode is really important for those reasons. Yeah.

Naren Arulrajah: Absolutely. I think the timing is perfect, Ben. I have been seeing more and more conversations online, especially in private Facebook groups and even like Reddit and other forums, where dentists are angry, they’re frustrated about shrinking reimbursements. Uh, you know, for example, low Delta Dental fees and just feeling trapped. I mean, literally the word is "trapped." And imagine that feeling, right? I mean, you are a doctor. You have, you know, 10 extra years of education just so that you don’t have to live the life of everybody else, but still you are feeling trapped. And we feel trapped when we feel like we are not in control.

And you have been in this insurance world, especially the dental world, for a very, very, very long time. What’s going on, Ben, and why do you feel—why does it feel like things are getting worse for private practice owners?

Ben Tuinei: So, Naren, let me first start by saying you’re absolutely right about something that you said, that the frustration is real in terms of how doctors feel against the insurance industry, right? And I feel like we’ve reached a point where dental insurance in general, especially when you look at the PPOs, they’ve sort of become the default system. And most dentists, they’re sort of stuck inside of that system without even realizing that they’ve lost control or they’re continuing to lose control.

If you really think about it, Naren, about half of Americans have dental insurance, you know, and that might sound great to some, but the reality is that those same PPOs have leveled the playing field. They’ve sort of made everything difficult for those that are in network. You know, so when it comes to those that are in network, everybody’s on the same directory.

All the doctors are listed in the same place, and fees keep going down, right? So you’re listed among all your peers when you’re in network. And that might sound like a great marketing tool, but it’s not. But if you are, you have to consider the cost, right? Because with those really, really steep write-offs, it starts to look like a very expensive marketing effort, right?

You know, so that’s why you’re seeing so much anger online, where dentists feel like they’re highly trained professionals and their income is being dictated by the corporate world that doesn’t even understand patient care, right? And because the profession is very fragmented—you know, where you have private owners, you have DSOs, and you have specialists—there’s really no unified voice to push back effectively against these instruments. And then we have laws, antitrust laws, that really handcuff our associations. You know, so it’s not just the financial frustration anymore; it’s really becoming emotional for dentists, right?

Ben Tuinei: And it’s entirely because I think the dentists feel powerless there. So that’s where we’re at. So when you think about that, Naren—and I don’t mean to be a Debbie Downer on that—we’re gonna build up some positivity in terms of how we could use this to our advantage, you know?

Now, when dentists talk about dropping PPOs, the biggest fear I hear today is, "If I leave the network, I’m gonna lose either half or all of my patients." So, Naren, question for you is, from your perspective on the marketing side of things, how does a practice even begin to overcome that particular fear of loss when they go out of network?

Naren Arulrajah: You know, that’s a great, great, great question. I do think fear drives us. I mean, if I were to tell you, Ben, "You take that vaccine and your chance of living goes up by 5%," versus I tell you, "You don’t take that vaccine and there’s a 5% chance you’re gonna die," I guarantee the second one motivates you 10 times more than the first one.

Again, this is not new. Daniel Kahneman and a lot of other people have studied this. These are Nobel Prize-winning economists—the late Daniel Kahneman—and they found this, right? Fear motivates people. So I think PPOs have put this trap where people feel like if they leave, they’re gonna be in trouble, right? That fear is kind of why they stay on that boiling pot as the, you know, the pot continues to get warmer and warmer and eventually boils the frog.

So I think I have to give it to the PPO companies for doing such a great job in making doctors feel like they have no option and they’re stuck and so forth. But you can overcome fear, and I’ll tell you a story that kind of shows how this can be done.

See, when you have options, you don’t have fear, right? I mean, if you look at—I’m sure some of you may have looked at or seen movies like I have seen, or heard about stories—where some people are in abusive relationships, right? And a lot of times the person who’s being abused feels like they have no option. In other words, if they were to leave that abuser, they’d be on the street. That’s literally what they feel. And their option is, "Okay, it’s me and my kids being on the street versus me getting abused all day long."

Naren Arulrajah: That’s the better choice. So that fear of the unknown makes them stick in those kinds of relationships. I kind of remember there was this amazing show about this one person and how she finally broke out and how she—it’s a true story, it’s a documentary—I can’t remember the name of the show or the TV network I saw her on, but it just really, really moved me.

So I think you have to overcome that fear. So this particular doctor that I’m thinking of, we started working together in 2011, and she’s a doctor in Virginia. And she, um, you know, was working around four days a week and making, at that time, around $600,000. And she was getting tired because she was seeing so many patients—100% PPO—and she just was tired because she was working so hard for so little money.

And then we—I met her at a conference, and, you know, many of her colleagues, especially of that association, were using us—the president, the former president, etc. So she’s like, "These guys can’t be idiots. They are running this academy, and they’re like the leaders of this academy. So if they’re doing this, then maybe let me try it."

So she took a gamble, she spent, you know, $1,200 a month, and she started working with us just to start attracting patients who are not just coming from PPO plans. Before you know it, she went from no new patients from marketing to 30 new patients from marketing. Wow. And, you know, her husband is again an awesome guy. He works for the government and, you know, smart guy. He’s a very strategic guy, and I guess they have an awesome marriage.

I met them and I know their son as well. And, uh, you know, so they always talk about what’s going on with their business. And I guess together they decided, "Hey, I don’t want to work an extra day to keep up with these—to take care of these 30 new patients. Let me see if I can get rid of a PPO plan." And they just looked at the one that abuses them the most, right? And hopefully a small plan. They dropped it.

You know what? Nothing happened. She didn’t have to work more, but before she realized it, she started making more money. That $600,000 went to $700,000. And I didn’t know this because, you know, they’re very quiet people. They don’t like bug me or, you know, even talk to me as the CEO of the business. But down the road, two to three years later, I found out their practice was now doing $1.3 million, and the doctor was working three days.

So one by one, by one by one, they got rid of these PPO patients. So imagine, right? You’re spending your day making 50 cents on the dollar. You’re replacing that part of the day and replacing it with patients who are paying you full fee and opting for high-value services. So almost like you’re making two, three times the money taking care of patients who appreciate you versus, you know, relying on these PPO plans that were like abusing the practice.

So before you know it, she went from four and a half days—or four days—to three days, and $600,000 to $650,000 to $1.3 million, working one day less and making twice the money. Of course, it changed her life. Now she started enjoying dentistry and she started, you know, looking forward to it because she was working less. And so that’s the same strategy I would recommend to you—start investing.

Naren Arulrajah: You are not—you don’t need to make a big, you know, investment. Just $1,250 a month. Within a year, you should be getting at least 20 new patients from Google and from organic marketing. Now, as you start getting those patients, then start dropping these PPO plans.

I know some of you, you know, have the guts to just jump off an airplane. My daughter is one of those people—on her 21st birthday, she just jumps off a plane, and that’s how she celebrates, right? But I won’t do that, especially on my 21st birthday or any birthday. Maybe when I’m 90, I might do it, because I’m like, “Okay, well, you know, who cares? I’ve lived a great life.” But I’m not gonna do that.

I know there are people who do that, so I’m not in any way saying you can’t do that or you shouldn’t do that.

In other words, start resigning before you even start building up your marketing. But if you are one of those people who’s kind of afraid—like most humans are—and who’s driven by fear more so than, you know, taking risks, then do this like what this particular doctor did in Virginia, right? Start replacing those patients with high-quality patients who are choosing you through SEO.

So she—she doesn’t spend a dime on Google Ads. And even after like 15 years—of course, she sold the practice and we continued working with the new owner and so forth—this strategy works for them.

So how do you know you’re succeeding? You’re ranking for 100 or more keywords, you’re getting 20 or more new patients who are coming to you not because you are doing free dentistry—at least that’s what PPO patients think—but rather you are doing the things they care about.

Also, don’t forget Google reviews. So an SEO company can definitely help people find you—a good one—by helping you rank for hundreds of keywords and getting at least 20 new patients a month. It takes time. It takes a year. But in the meantime, you also need to start getting more and more five-star Google reviews.

That’s the only thing she did. So slowly she started getting three reviews, four reviews, five reviews, and eventually 10, even 15 reviews a month. She got good at it. She started asking all these people who were paying full fee, “What do you think about us?” And they said, “Oh, we love you. You are amazing. Your team is awesome.” And those became the Google reviews.

So I think it’s a really smart way to, you know, start removing the shackles—removing this, you know, need to live in fear—by just starting to, before you even drop the PPO plans, starting to find patients who are coming to you through Google.

Ben, I’ve seen some dentists online say, “We should all band together and fight back against insurance companies.” But legally and practically, I don’t know if people have made much progress. You’ve been in this industry at least for a couple of decades, and I know people have been trying this for, you know, four or five decades. What do you say to dentists who want to take action—to change their own life and their own future—but feel like they can’t do it individually?

Ben Tuinei: Yeah. This is a very, very, very important question. And it’s something that I wish more people understood. And I wish we had more, um, legal options out there. Because the reality is, when you look at formation—formation of a union or a collective body or an association with the intent to negotiate with any insurance company—it is strictly prohibited by antitrust laws. And groups of doctors have gotten into trouble for trying.

So that’s why change at the insurance company level—I mean, it’s impossible to ask insurance companies to make that change. It has to come from political reform, unfortunately. But that doesn’t mean that you, as a provider, are powerless, right? What you can take control of is your business model, your systems, your patients, you know—your ability to go out of network.

And controlling the perception of your patients so that they stay. So what that means is knowing which PPOs you’re in and what they’re actually paying you. What is your profit? What are your margins on that PPO plan? You also have to renegotiate—renegotiate regularly, right? Because non-negotiable fees just destroy your margins in a big way.

And then, of course, training your team members to be as confident as they can be. For those of you that are going out of network or are out of network, you have to have a high level of training for your team members to be able to explain out-of-network benefits proficiently to patients—and in a way that’s friendly, right? And not scary.

So it’s not about, to me at least, it’s not about fighting the insurance companies collectively as dentists—because we can only do so much. It really is about building a system and a plan of action to be independent from them. So that’s my recommendation, Naren.

Naren Arulrajah: No, that’s a good point. I think—I don’t know—I feel like if you ask most dentists why they decided to own a practice, they would say by far the number one reason is to be independent. Money and everything else is, you know, nice to have. But really being able to see the patients they want to see, do dentistry they want to do, work with the team they want to work with—that’s why they became practice owners, right?

Ben Tuinei: Yep.

Naren Arulrajah: But this insurance kills that independence. So I do think getting rid of those shackles that are killing your independence is really smart.

Ben Tuinei: Naren, I really love that—taking back control at the practice level. So, for a dentist who’s ready to take that next step, how can marketing play a big role in sort of building that mission of being independent from insurance?

Naren Arulrajah: You know, that’s a great, great, great question, Ben. I think you’re asking the right question, right? You know, if you can become independent, then you can control your life. You can control your destiny. You can control your future.

This is where I believe strategy becomes everything. Ben, marketing isn’t about visibility; it’s about positioning. If you can make patients see you as the trusted local expert—not just another dentist who takes my insurance—you win. Let me repeat: if you can make your patients see you as the trusted local expert, not just another dentist who takes my insurance, you win.

You know, especially after COVID, Ben, people really, really pay a lot of premium to the relationship they have with the healthcare provider. Health is no longer a nice-to-have or a checkbox, but rather something at the core of their existence. Especially those of us—I’m sure you are in the same camp, Ben—like, once you pass a certain age, let’s say 40, 45, you realize the one thing you can’t lose is health.

And especially as a civilization, as a community or a society, you know, our quality of life and, you know, all these metrics are improving—health becomes even more and more important.

So the question is, how do you become seen as the trusted local expert versus just another dentist who takes my insurance? There are four building blocks that I think we should touch on.

Number one, you need to be trusted. And one of the best ways to earn trust in 2025 and beyond is Google reviews, right? So I have said this many times, you have heard me preach this, and many of my clients know I live by this with them—try to get at least 10 or more five-star, letter-length Google reviews every month. There’s some magic that’s there. If you are getting 10 or more five-star paragraph reviews every month, it creates this flywheel to move in your direction.

Naren Arulrajah: I don’t know what it is, but I’ve been doing this for 18 years—I know that’s the magic number. Now, if you can get 15, I’m not gonna say no. But ten five-star, letter-length paragraph reviews—new reviews—is the key mark.

Second is, you know, people need to find that expert. How do they find that expert? They go to Google. You know, for example, they’re looking for an expert for Invisalign. What do they do? They go to Google—“Invisalign dentist near me,” “Invisalign”—you know, they type in the zip code, “best Invisalign doctor,” you name it. So they’re looking to Google to find those experts.

Remember, we want to become the trusted experts. So are you the one they’re finding—or your competition? Right? And for all the different services you want to excel at, and you want to, you know, really do a good job—make sure you are showing up. You are ranking—not through ads, but organically, for free.

And the magic number is 100 or more of these kinds of phrases and keywords related to all the different things you do. You should be ranking for at least 100. Why did I pick 100? Again, over 18 years, I have figured out that those who are doing really well with Google SEO tend to get all the benefit from it. Like, 95% of the free traffic comes to those who are ranking for 100 or more keywords.

So definitely lean into that. Continue to lean into dominating local SEO.

And finally—or the third point—is your website has to speak to them, has to convince them. In the old days, you know, they’d come to your office and then they would be convinced. Now, they won’t even pick up the phone and call you till they’re convinced.

Naren Arulrajah: So how do you convince them? So, for example—again, going back to Invisalign—do you have real cases, especially full-face after pictures, showing how you can change somebody’s life with the help of Invisalign, with the help of veneers, or whatever else you do, right? Implants?

Like, do you have these cases? And I’m a huge fan of those full-face after pictures. I know you might be saying, “Oh, I don’t know, it won’t work.” Trust me, it can work. If anyone is interested, you know, just go to insuranceuntangled.com and contact us, and we’ll tell you how we have helped other clients do this.

You really, really, really can attract patients who care about quality by showcasing those pictures.

Of course, make it easy, right? Simple call to action. A website that loads fast, that works on every device.

Naren Arulrajah: These are all things you can do to make a massive difference. And last but not least, use targeted ads to reach the right patients—the ones willing to invest in quality care.

Now, this is also important, especially for startups or if you want to use targeted ads as a temporary means to, you know, boost your new patient numbers for a certain type of procedure. Why am I calling it only for startups or for a temporary basis to boost certain high-value services? Because it can be five to ten times more expensive on a new patient basis compared to SEO. So, you know—yeah, if you can get the same benefit for one-fifth the cost, why would you spend five times as much again and again and again?

I know ads are the easiest ways to get new patients—at least from the company’s perspective. So a lot of people push ads, and that’s why a lot of dentists end up spending tens of thousands of dollars or $5,000 just like that, you know, because it’s so expensive.

So I don’t recommend that as a default option. I do recommend SEO and Google reviews and a website that speaks to them with photos as the default. But use ads as a, you know, as a fill-in. When the foundation is in place, you’re no longer reacting to fees not going up when your costs are going up. You’re no longer feeling trapped. You’re no longer feeling like you don’t have a choice. You’re no longer, you know, hating Monday mornings because you know, “Man, I have to work harder to make the same money I used to make working less two years ago.”

So everything changes—not just for you, but for your team, your morale, even your patients.

The more you start dropping these plans—remember I shared a story with you about a real client—how she was able to drop these PPO plans. Remember, she was working less, making twice as much money, and she loved dentistry because she could speak to the patients, she could spend time on these big cases and, you know, do a $20,000 case versus, you know, do something where she gets paid $100 from insurance after all the write-offs.

So it changes the whole game. And of course, then it allowed her—she’s one of those people who likes to give back—so she became very active in the dental community and helped other dentists. She did all kinds of things with her life. She didn’t, like, you know, retire and just give up. She just expanded her life, made a bigger difference as she started going down this path.

Ben Tuinei: Yeah, no, I love that, Naren. I love that. You know, and if you’re listening to this as a dentist and you’ve been feeling sort of stuck in this world of PPOs and feeling the frustration that everybody’s feeling against those PPOs…

And the other part is that the common theme is that, you know, dentists are working hard. They don’t feel that their work is paying off, you know, or it’s profitable.

So here’s the takeaway: you are not alone. You really aren’t alone. But doing nothing—it really isn’t an option. You have to take action in doing something to counteract these frustrations these days.

Naren Arulrajah: Exactly. This is the moment to take control, Ben. You can’t fight the insurance giants head-to-head—you have to play a different game. But you can build your practice and make it stronger. You can attract patients who care about your expertise, your experience, your knowledge, your ability to provide certain types of dental services that are much higher quality.

Attract them through SEO. Attract them through Google reviews. Attract them through compelling websites. And if you want to find out how you are doing in general when it comes to the top of the top in this game of attracting patients through marketing, book a marketing strategy meeting. The link is insuranceuntangled.com/msm.

And that’s where I would start. We spend six hours—it’s a $900 value—we look at you, we look at your competition, and we’ll tell you where you stand.

Are you in the top 5%? Are you in the bottom 5%? Doesn’t matter where you start, right? What matters is where you end up. Now that you know where you are versus your competition, we’ll also give you a plan to get into that top 5%.

So take advantage of it. Whether you work with us or not, it doesn’t matter. At least you need to know: how can you take control of your future? How can you create an alternative pathway where you don’t feel like you’re stuck with PPO plans?

And the link again is insuranceuntangled.com/msm. 

And I want to take a minute, Ben, to thank you for co-hosting this episode with me. And if you, as a listener, enjoyed this episode, please write a review for us. Please tell your friends. And of course, please visit insuranceuntangled.com for future webinars and episodes that might interest you.

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