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Gary believes that nearly every dentist would love to resign from PPO Plans but only very few of them actually do.

“Why is that?”

In Gary’s 40+ years of coaching 2,200+ dental practices, he discovered the 5 most common reasons why dentists don’t resign from PPO’s.

In this episode, Gary and Naren talk about these 5 reasons in-depth while also sharing suggestions on how you can overcome each one of them.


  • Introduction to today’s topic > 00:51
  • About the number one dental podcast: The Thriving Dentist Show > 01:10
  • Reason #1 – The Dentist doesn’t actually know the financial impact of being in-network with dental insurance > 07:09
  • Reason #2 – The dentist doesn’t know how to market to patients without insurance > 08:47
  • Reason #3 – The dentist doesn’t have any role models to inspire them > 09:38
  • Reason #4 – Lack of support from team members > 10:53
  • Reason #5 – Dentists feel like it can’t be done in their city or town > 13:22



This is the Less Insurance Dependence podcast with my good friend Gary Takacs and myself, Naren Arulrajah. 


We appreciate your listenership, we appreciate your time we appreciate your intention to reduce insurance dependency in your practice. Our goal is to provide information to you that will allow you to successfully reduce insurance dependency in your practice and make this your best year yet. Thank you.


Welcome to another episode of the Less Insurance Dependence podcast, I am Naren your podcast cohost – today we have an exciting topic. The topic is The 5 Biggest Reasons Dentists Don’t Resign from PPO Plans. Before we jump into the episode I have a quick announcement – many of you know that Gary is the pod-father, he is the very first one in dentistry to start podcasting, and that podcasts called the Thriving Dentist Show. You can access it by going to the website the thriving dentist. com, now a couple of trivia points – number one it is your first podcast that was every launched in dentistry – number two it is listened to in more than one hundred and eighty five countries across the globe and the farm ad is also very interesting, every week without fail Gary goes through a topic that is based on the question he gets either from his clients or from him many many many fans all across the globe and for example the latest topic was – this s the last episode we published and as we are publishing this, it is called the one metric you must know if you are a PPO practice – so if you love listening to the Less Insurance Dependence you are going to love the thriving dentist show that is four hundred and forty eight episodes that are already live and by the time you listen to this we have already crossed four hundred and fifty episodes, so binge listen to it if you want or just listen to one or two episodes that you like so that is just our invitation to you to go check out the thriving dentist show and lets jump in – Gary how are you doing today?


Hey Naren I am doing great – thanks for talking about the thriving dentist who we know we get new listeners every week that find the Less Insurance Dependence podcast and it occurred to us  that some may not know that we have another pod act called the thriving dentist show and we know that if they loved the  Less Insurance Dependence show that they are going to love the thriving dentist show, now they are different but they go hand in hand because they both help develop a thriving practice


Yeah, the way I see it they get to listen to their number one coach on the planet when it comes to the business and people side of dentistry and it is free you know and they can listen to it anytime they want – so that is two big benefits! So feel free to check it out any time you want.


we will be sure to put a link in the show notes so if you are driving don’t take your hands off the wheel, but when you are stationary got to the show notes – right here in the Less Insurance dependence if you scroll down you will see al ink and it will take you directly to the thriving dentist show – or you can fund it on iTunes or Google Play. And we have a fun topic for today – The 5 Biggest Reasons Dentists Don’t Resign from PPO Plans. It is interesting because I believe that nearly every dentist would like to resign from PPO plans but very few of them actually do – so why is that? I sort of started asking this question a couple of years ago – well why not? And I discovered some commonalities – so there was some common thread so I actually identified 5, 5 of the biggest reasons – there are more than that, but I will bet that every one of our listeners will identify with either one or more of these reasons, because it is these reasons that are blocking you from taking action, so there is some kind of fun here Naren. I’m going to identify the 5 Biggest Reasons and then I am going to suggest how to overcome each one 




And I think maybe this will inspire our listeners our doctors to identify their own reasons and you know and maybe they will recognize and say they wait a minute that is me! That’s what I was thinking! And that is why I am frozen. Naren have you ever set out to do something and whatever it is whatever realm it is kind of just frozen because you did not know where to start or you did not know how to overcome some hurdle you saw? Has that ever happened to you? That happens to me every week 


I mean absolutely – I will give you a personal example. Early on in my career I did my own taxes and I hit you know those details and numbers and just hated it – I just liked big ideas and the 10,000 foot – I mean every bill and every dollar – and twenty-four cents so what I would do is I would ignore it ignore it and then finally when something bad is going to happen – I wake up and realize – I do not need to do this – I can hire someone who can do this and take care of me.

Gary: Right


And version one was we just took all these papers and gave it to them, but now we found a  better firm that just lets us automatically upload things – so it is all in the cloud and it Is connected to our bank we do not upload anything it just magically everything shows up and the only thing we have to do is kind of categorize and make sure it is in the right bucket so it is the same situation but my mindset and maybe the approach that changed and all of a sudden no big deal – it was handled. I don’t know if that is a good example but –


that is a great example – oftentimes, when we are handling something we hit, the big hurdle

Naren: Yeah 


and the big hurdle just stops us and in this hurdle, you are going to find out how to burst through each one of those hurdles and take some action on reducing your PPO involvements. So kind of fun, can I dive right in? We have 5 of them

Naren: Yes


I have numbered them one to five and they are not numbered in importance – they are of equal importance but I will number them so that there is some structure to the podcast. So number one – remember that these are the five biggest reasons dentist don’t resign from PPO plans.

Number one – the dentist does not actually know the financial impact of actually being in network. Now think abbot that for a minute Naren.

Naren: Yep


They don’t know and I think this is a big one – because if they truly knew it would be perhaps the most inspiring information they could have as to why they should be out of network, so let’s list each one of these and come back to suggest solutions – so before I go to number two though I think what is common is I think the dentist knows that PPO participation has a negative effect but they just don’t know how bad, how much

Naren: Yeah

Gary: You know it is like I know I shouldn’t eat this but you plug it in

Naren: Yeah McDonalds

Gary: Yeah fast food – I know I should not eat this I know that but they don’t really know how bad it is 

Naren: Right

Gary: And if they knew how bad it is they would say no no I am not good to do that 

Naren: Right

Gary: So number one the dentist doesn’t actually know

Naren: Gary really quick – is it okay if we include that podcast episode that you did?

Gary: Yeah that is what I am going to- you got ahead of me Naren that was the solution

Naren: Oh okay never mind okay keep going 

Gary: We are going to help them understand what happens in their practice including the PPO write off calculator so they can know what that actually is. I’ll come back to that

Naren: Perfect

Gary: Okay number 2 – the dentist doesn’t know how to successfully market to get patients other than being on an insurance plan 

Naren: Right

Gary: The practice is infected with PPO plans which means the vast majority of ways in which the patient chooses them is that they are on the plan and as a result of all of that activity coming in they have never really been inspired to market any other way to attract patients other than the ones on their plan so they do not know how to market

Naren: Right

Gary: And there is a good solution for that one – each one of these have a solution which is I hope you are interpreting this as good news. Number 3 – the dentist doesn’t really have any role models to motivate and inspired them to let them know that this can be done – you know if the entire world that you live in and all your dental colleagues are in dentistry network then you might kind of resign to the fact that – well I guess that is just the way this is 

Naren: Right

Gary: Apparently nobody is out of network – I mean they kind of are the kind of unicorns do they really exist?

Naren: That is a saying isn’t it – you are the five most people you spend time with 

Gary: Yes you become the 5 people you spend the most time with an if most dentist statistically are your colleagues are going to be PPO providers if that is the world that they travel in – they network in then that is all they see and pretty soon it becomes kind of a self- perpetuating process – well I guess that is just how it is and you kind of resign well as much as I would like to do that I really think it is actually kind of wishful thinking g I can’t do that, so that is reason number 3. Reason number 4 – lack of support from their team members, the talk to their office manager and their office manager goes oh no no doctor we could never do that, if we do that we would lose all of our patients and the doctor just got confirmation of a fear that he or she has. Can you imagine that Naren? 

Naren: Yeah

Gary: Going to your office manager and saying Linda I am thinking about resigning from Po plans what do you think, oh no no no doctor we will lose all of our patients – right oh okay never mind

Naren: Just give up exactly

Gary: And I am not faulting the tam member there- the only experience she has in dentistry is with the PPO practice and so the lenses that she looks through, I believe her heart  is in the right place, but it is  – she is not informed and she does not have an experience base outside of that and I don’t believe she is trying to torpedo the dentist I believe that she is genuinely concerned for the dentist which is fair but imagine if it were that blunt oh no doctor no doctor we would really lose all of our patients – that would really, if the doctor was kind of fragile on thinking about whether I can do this or not and they get that from a trusted team member that’s going to kind of heavily hit the brakes you won’t tap the breaks 

Naren: Right

Gary: You are going to hit it as hard as you can

Naren: Right

Gary: And no I am not being disparaging to a team member who holds that perspective that is a fair perspective

Naren: Absolutely and again then again that is all they know so I mean like we went to school in Chicago and my school IIT is outside of Chicago was in the south side of Chicago where there are a lot of projects and t is very sad because most of these buildings have bullet holes and if you are growing up in an environment where this is everything you see and this is everything you know it is hard to kind of you know escape that 

Gary: Yeah it is really a cycle that is hard to break

Naren: Yeah

Gary: Yeah that cycle outside of Chicago is a terrible cycle for many but also the cycle of PPO plans is something that is hard to break through – the reason number 4 – lack of support from team members and reason number 5 – they think thy can’t do it in their town or their city or their area I don’t think I will be able to I adjust don’t think I will be able to do it here and you lug in the reasons why and it becomes irrational – I think this can be done somewhere but I do not think I could do it here. So those are the 5, so those are not arbitrary those come up after me asking that question from thousands of dentists, doctor what stops you from resigning from a PPO plan and those are the 5 common answers, so let’s go through and find a solution for each one.

Naren: Right perfect so let’s jump in Gary let’s give the solutions

Gary: right so let’s go back o number 1 – actually know the financial impact of being in network. 

You know we mentioned at the top of the show of the other podcast we do called the thriving dentist show. We did an episode recently about the one metric that dental insurance companies don’t want you to know and it is all about essentially covering up what the discounts are what the adjustments are so you don’t know the impact of that. So what I would like to do is put a link to that episode in the show notes and that’s our thriving dentist show link, and while we do that, in that episode we talk abbot PPO insurance plan calculator to calculate exactly what your adjustments and discounts are from PPo plans and we will put a link to that calculator in the show notes here as well and the reason why – if I can just know the top off it, the reason why dentists don’t know is – nine out of ten dentists enter their adjusted fees into their practice management software – no the actual fees but the adjusted fees and that is on the guidance of their dental insurance practice management – their practice management software – so whether it is Dentrix eagelsoft open dental or soft dent, whatever software they use nine out of ten dentists enter their contracted fees not their UCR fees.

Naren: Right

Gary: And they don’t know as a result they never know, you know I ran through this exercise earlier this week with a potential client and this was a nice strong practice and I asked him do you know what your write offs are – your insurance write offs? And he said Gary I don’t know I entered my fees I followed the advice of Dentrix and I entered my contracted fees. I asked him if he would be interested in knowing he said yeah and I went through the calculator with him and we discovered that this office had over 400,00 dollars a year in insurance write offs  – 400,000 if you, let’s use 400,00 as a round off but it was actually more than that, but 400,00 divided by 12 a month is 33,333 dollars a month so I told this doctor – doc you are spending 33,333 dollars a month on marketing and he said no no Gary I think you are looking at the wrong this on my profit and loss statement, I know I spend money on marketing but I am not spending that much. We were on a zoom meeting like this and he can see my face and I can see his face in the video. So I said doc look at my face in the video and I said doc you are spending and I used air quotes and I said doc you are spending 33,333 dollars a month on marketing and when I did that the light bulb went off in his head – and he said oh my gosh I am paying that. The reason why I say you are spending that much on marketing is because the insurance comp

any is providing you with patients 

Naren: Right

Gary: And as soon as I said that to him it was literally like the flood gates of understanding were opened to him. That’s why I said the number one reason is that they don’t know the financial impact to participate in the plan. When I tell you that – did you realize that you are spending 33,333 dollars a month on marketing? Instantly they think wait a minute there is a better way – I may be doing that now but I am not going to do that in the future.

Naren: Right makes sense because they don’t know like you know out of sight out of mind 0 you don’t realize it because they don’t know and it doesn’t hurt you and you don’t see it

Gary: You don’t know

Naren: Yeah

Gary: And know they know, you know that would be a good quote to accompany this episode when we know better we do better.

Naren: I love that quote – yeah.

Gary: You two when we know better we do that – and that is just a specific example, of hat quote and that can apply in may avenues of our life but certainly it applies to this area making decisions right, okay he second one – the dentist doesn’t know how to market for patients other than being on the dental insurance plan. And I am just going to be very direct – follow my lead just do what I do. We are an EKWA client – EKWA is your company Naren. My practice – Life Smiles is a paying EKWA client and it’s the best marketing return on investment that I have ever got on my 13 years of ownership of my life smiles dental care. We are one of your platinum clients 

Naren: Yes

Gary: And we play 1200 dollars a month for all inclusive comprehensive services, it ids a flat fee and it is all inclusive, it doesn’t go up it is fixed and it provides us with 80 new patients a month and every one of those are choosing us for other reason – other reasons hat were influencing them to choose up – and just do what we do on that one – what a great way to instantly get on the oath to mastering marketing in your practice.

Naren: Right and you spend 1.8% compared to the 38% that you used to spend 

Gary: I mean think about that – if I analyze that – the doctor who is spending 33,333 dollars a month if he was to go with EKWA he is now going to spend 14,400 a year?

Naren: Yes If I get my math right, let’s call it 15 just to round that up – so let’s spend 15,000 dollars a year instead of 400, and get t the added benefit of having his patients choosing him for other reasons on their plan –

Gary: Right

So there you go, okay – role number 3 – no real role models to inspire the dentist to break free and move from insurance. Here I would like to invite our listeners I can be your role model.

Naren: We were just talking to a client of yours recently Gary – he first was our client and he then became your client – he has been listening to you to two years now since your launched the Less Insurance Dependence show and he literally told me that every day I am surrounded any someone who really knows what he is doing had done it before and is part of the community he is part of the I love dentistry Facebook group so he gets positive reinforcement every day along with the other 5500 members. So I believe you have created tribe of people – you know I love that quote – if it has been done before it must be possible something-

Gary: I was about to; say doctor reed taught me that one. I believe it came from somewhere else but I always give him credit because that is where I learned it from – it has been done before so it must be possible and let me go a step further Naren. On the thriving dentist show I am owing to put a link in the show notes her of three dentist who have done fee for service practices and they are youg dentist who have successfully created fee for service practices – we are going to put a link to those 3 in the show notes here so they can listen to these again because it is not just me but others who have done this

Naren: Right

Gary: It is very cool ND these are awesome young dentist – and it gets better I had to think about it, all 3 started a fee for service practice from scratch in a highly competitive area by the way what do you think all three of these dentist heard as they announced their plan to their dental friends? 

Naren: Yeah not possible 

Gary: You cant do that that’s not – don’t you realize how competitive it is? 

Naren: Yeah

Gary: And all three of these docs seemed to have the same kind of temperament that I do – I love it when people tell l me I cannot do something. 

Naren: Right

Gary: Sometimes I think my wife does that to me because she knows exactly how it triggers me in a positive way

Naren: exactly

Gary: She knows something you know literally at the core done at the cellular level I can go yeah just watch. So how cool is that – they can have 4 mentors and 4 different voices different areas different perspectives – all showing them that it can be done.

Naren: Right

Gary: Number 4 lack of support from team members – here’s what I want you to do on that one doctor start talking to your team members about what is in it for them – as you work to resign from PPO plans – think about that. Think about Linda the office manager – think about what she said, oh doc you can’t do that. Think about this is what would our life be like as my office manager if we didn’t have people from the PPO plans? Start talking to them about what is in it for them – and I don’t mean a one bullet point conversation – multiple bullet points. Doctor if you feel like a hamster in treadmill as a dentist providing care in a PPO practice how do you think your team members feel? They are also hamsters on a treadmill

Naren: Right

Gary: And you know how you feel how patients say I don’t want to come if they don’t have my insurance and imagine how your team members feel when thy – your team members want to help people and the truth is when you are in network you are not able to help people as fully as you can, start talking to them about these things.

Naren: The other thing you taught me Gary was you didn’t make your podcast – this one no insurance you said less insurance dependence right so one step at a time, one foot in front of the other – it is not over whelming but if I tell you need to do a full minute mile tomorrow you are going to say forget it, but if I tell you les go for a 7 minute I don’t know what your response would be 

Gary: You experienced that!

Naren: Yeah 

Gary: Use the process that we can follow

Naren: Exactly 

Gary: It is baby steps that I cn do that

Naren: Yeah

Gary: I can do that – 

Naren: It is like driving at night all you can see is the next hundred meters but that all you need.

Gary: Yes that’s all you need to start – yeah that s a great point so we want you to provide you some information to your team members so that they can support you in this. Number 5 they think they cannot do it in their town. Well I would like to answer that right now – we have been successful as a coach, I have been successful as a coach with dentists in every type of location environment big cities suburban locations big towns smaller towns small tons, rural remote and every kind of practice environment has been successful. Hers how I want you to think about this – how many patients do you need to have a great practice? Really again it all depends on your goals your size as so on but I think that any of our listeners would agree that somewhere between 1500 and 2000 active patients would make a really good practice – 

Naren: Right

Gary: And you can find those people in every kind of location and you can find people who don’t have insurance because when they don’t have insurance they don’t ask you two questions – one are you in network? And two when you resent treatment they don’t ask you to cover by insurance 

Naren: Right

Gary: And three groups of people you can find think of them as silos of people – one would be retirees – retires wouldn’t have insurance –typically another group would be the other end of the age spectrum – millennial, people who in their 20s and 30s – they have not reached the point in their careers where they have accorded benefits and then the third group which is kind of  a catch all group and is kind of a big group is the gig economy workers – gig economy workers are independent workers they are freelance workers, independent contractors – Uber drivers, lift  drivers, freelance workers Etsy shop owners BnB owners and that group is expanding so I ask myself are those people – we found those people in every type of location , and If you are in an area that is highly corporate maybe you are in an area like Huston or a city like Chicago that is highly corporate – ask your self could I find myself patients who are retirees millennial and gig workers and every time the answer is oh yea and those groups of people are much larger than you think when you start to circulate in those areas, it’s like that comment about buying a new care that is a red car what happens? We start to see red cars everywhere.

Naren: Exactly

Gary: And when you start trying to attract retirees you think here is all the places I can find retirees in my community 

Naren: Right

Gary: And so there is the 5 ways, the 5 biggest reason and then the counteract to all of those is how to overcome each one f those well Naren I hope this has been inspiring for our listener to overcome what I hope have been the hurdles for them and I hope that this inspires them to take action and to continue down that path just to successfully reduce insurance dependence – we are in the middle of creating our grass roots movement and I am so encouraged by the results we are seeing  you know it’s all about helping the dentist – it is about providing personal professional and financial satisfaction and perhaps the most strategic thing you could do to achieve those ends is to successfully reduce insurance dependence 

Naren: Absolutely Gary and going back to what I said at the beginning of the podcast – if you are a fan of the less insurance dependence show you are going to be a fan of the thriving dentist who and we are going to put in a link and we want to give away some swag so do us a favor go to the thriving dentist show – you can listen to one episode, 5 episodes or even 50 you can binge listen if you want and then write us a review so if you write a review of r the thriving dentist show and you do I in the next week or two we are going to pick a winner and you are going to get swag – so you will get a thriving dentist swag

Gary: And we have some cool swag Naren I have to admit we’ve got some very cool swag so yeah jump on tunes and write us a review and get some fun swag to go along for it and if you write us a review for less insurance dependence we will send you a less insurance dependence swag so we will pick on the winner each week.

Naren: Well thanks so much for listening I look forward to the next less insurance dependence podcast.

Gary Takacs

Gary Takacs One of Gary's most significant achievements as a dental practice management coach is transforming his own practice, LifeSmiles, from one that was infected with PPO plans, no effective marketing strategy, and an overhead of 80% to a very successful dental practice that is currently one of the top-performing practices in the US.

With over 2,200 coaching clients, Gary has first-hand experience transforming insurance-dependent practices into thriving and profitable practices.

Through his Personalized Coaching Program, Gary shares access to the systems, strategies, processes, and experience gained over 41 years of coaching dentists and transforming over 2200 practices worldwide.

Learn More:
Connect with Gary Takacs on Linkedin

Naren Arulrajah

Naren ArulrajahAs CEO of Ekwa Marketing, Naren has over a decade of experience working with dental practices and helping them attract the ideal type of patients to their practices. It is his goal to help dentists do more of the type of dentistry they love with the help and support of effective digital marketing.

Ekwa’s "Done-For-You" Digital Marketing model blends fundamental persuasion principles with an all-in-one Digital Marketing solution to help your ideal patients find you and choose you for reasons other than being on their insurance plan.

If you’re interested in finding out if Ekwa is the right fit for you and your practice, book a Free Marketing Strategy Meeting with Ekwa’s Marketing Director, Lila Stone.

Book Free Marketing Strategy Meeting:

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