Demystifying Dental PPOs: How to Put More Money in Your Pocket (While Doing the Same Dentistry)

An Interview with Tracey Gutzmer of Dental Credential.

Dealing with insurance contracts in the dental office feels a bit like cleaning out the garage. You know you should do it…but does it have to be this weekend? 

The complexity can feel overwhelming. In fact, the strategy I see most often from dentists is ‘let your office manager handle it and hope for the best’.

Unfortunately, that approach might be costing you tens of thousands of dollars or more every year.

I recently sat down with Tracey Gutzmer of Dental Credential—someone I consider "the real deal" when it comes to PPO optimization—to break down exactly what practice owners need to know. Whether you're running an established practice or looking to buy one, these insights can directly impact your bottom line.

Why This Matters: It's Your Money

Every dollar you optimize from your PPO contracts flows directly to you. 

Your lab costs are fixed. Your staff is already there. Your facility costs aren't changing. 

So when you increase reimbursements by getting smarter about your contracts, that's pure profit.

Beyond the money, cleaning up your insurance situation simplifies life for your entire team. 

Better estimates for patients mean fewer surprise bills. Fewer surprise bills mean better Google reviews. 

It's a virtuous cycle that starts with understanding what contracts you actually have.

Understanding the Basics: Direct vs. Umbrella Contracts

Direct contracts are simple: a one-to-one relationship. 

You sign with Delta, you have a fee schedule with Delta, you're in network with Delta. Done.

Umbrella networks (also called lease agreements or shared networks) are more complex. 

Tracey uses the apartment building analogy: imagine the umbrella company (like Carrington) as the penthouse. You negotiate one fee schedule with them at the top, and that schedule "trickles down" to all the carriers in the building below.

Umbrella networks have pros and cons. 

The fee schedules are generally good, but they're harder to manage because those "apartments" below have some leeway—they can move out of the network, they can have different effective dates, and tracking everything becomes more complicated.

The Problem: Over-Credentialing and Stacked Contracts

All of these different opportunities to get contracted can pose a serious problem.

Tracey reported seeing this constantly: practices with contracts stacked on top of contracts, accumulated over years of well-meaning but unfocused decisions. 

A salesperson calls with a "great fee schedule," someone signs up, and suddenly you've got overlapping networks competing against each other.

The result? Your best fee schedules get buried under lower-paying ones. 

You may have a fantastic reimbursement rate with one carrier, but you never see it because three other contracts are paying first.

This is costing you time (through front office confusion), money (through lower reimbursement rates), and patients (through billing confusion and mix-ups). 

Fortunately, there’s a way out of this mess – and it’s not as complicated as you might think. (I would still call Tracey to have her help out though…)

Your First Step: Build Your Insurance Map

Tracey's first recommendation is straightforward but powerful: create a map of your insurance landscape. 

This is your "treatment plan" for your practice's PPO situation.

Here's how to do it:

1. List your top 10-15 insurance carriers by patient volume.
2. Call each carrier with your tax ID and ask: "How is my office in network with you?"
3. They'll tell you one of three things: you have a direct contract, you're coming through an umbrella/lease network, or you're out of network.
4. Document everything. Sometimes they'll say you have both a direct contract AND umbrella access—that's stacking, and it needs attention.

Pro tip: If you have multiple providers, check each one separately. You'd be surprised how often credentialing gets confused when associates are added over the years.

The One Thing Every Doctor Must Do: Bill Your UCR Fees

If there's one non-negotiable takeaway from this interview, it's this: make sure you're billing your UCR (usual, customary, and reasonable) fees to every insurance company, every time.

Why does this matter? Insurance companies have more data than you realize. 

When you submit claims at your allowable rate instead of your UCR, you're essentially telling them you're happy with the current reimbursement. 

When you try to negotiate higher fees later, they'll look at your submissions and say, "You're only billing this amount—why would we pay you more?"

Here's Tracey's quick diagnostic: 

“Look at your EOBs for in-network claims. If there's no write-off showing, you're leaving money on the table. Using the fluoride example: if you're billing $40 and getting paid $40 with no adjustment, the carrier might pay $42, $45, or more—you just don't know because you never asked.”

This should be automated in your practice management software. Contact your software vendor if you're not sure how to set it up.

Annual Fee Increases: Why They Matter More Than You Think

Increasing your master fee schedule annually isn't just about keeping up with inflation—it directly affects your negotiating power with insurance companies.

Many practices held fees flat during COVID to help patients. It was a noble intention, but the result was falling behind to the 40th or 50th percentile. Now those practices need a big jump to catch up, which is more noticeable to patients than consistent, smaller annual increases would have been.

Use the NDAS (National Dental Advisory Service) survey to benchmark your fees by zip code. Aim for at least the 80th percentile. 

And here's a practical tip: get your team's buy-in first. Ask them where they think your practice's quality ranks compared to others in the area. When they say "top 10% or 20%," you can show them the data and align fees accordingly.

For Sellers: The "Remodel” That Pays for Itself

If you're planning to sell in the next two to five years, optimizing your PPO contracts now is like doing a light remodel on your house before listing—except this remodel literally pays you while you wait.

We’ve all seen the shows on HGTV (or is it just me?) where sellers go to remodel their home before selling to maximize their listing price – and then they’re disappointed they didn’t do it earlier! The home looks beautiful, just in time for them to leave.

Your insurance contracts are similar. If you clean it up right before you sell, that’s great. It will make it easier for a buyer to step in. 

But if you clean it up in the years before a sale, you’re not only making it easier for the buyer, you’re also putting more money in your pocket now! Plus, that additional income = a higher sales price when you go to sell. It’s a win-win-win. 

By cleaning up redundant contracts and negotiating better fee schedules, you increase collections without doing more procedures. You benefit from increased income every month until the sale closes.

The Bottom Line

Your PPO contracts are how you get paid. Treating them with the same attention you'd give a major piece of equipment—or a treatment plan for a complex case—just makes sense.

The steps aren't complicated: build your map, eliminate redundant contracts, submit your UCR fees, and increase fees annually. You can do this yourself, or you can hire someone like Tracey to handle it. Either way, the money you're leaving on the table right now is yours for the taking.

About Tracey Gutzmer

Tracey Gutzmer is the founder of Dental Credential, helping dental practices nationwide with insurance optimization and credentialing. Contact her at dental-credential.com. She's spent over 25 years in the dental industry, helping private practices establish strong systems, boost productivity, and increase profitability. Throughout her career, she has successfully managed and transformed three dental practices into highly profitable businesses—always with the philosophy of patient health first, production second.

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