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Higher than PPO Negotiation For Startups [THE CITY-LINE STRATEGY: Dental PPO Fees]

Higher Fees than PPO Negotiation
for STARTUP Dental Offices

When opening startups, new practice owners are told to spend thousands on dental PPO Negotiations. Don’t fall for that trick.

In this article & video I will show you how to earn more from PPOs in your startup – even without PPO Negotiations – when you use the City-Line Strategy.

The City-Line Strategy gets you higher Fee reimbursements that you deserve. And it works for startups, specifically.

When you do this the right way, you reach profitability in your startup much faster. This can be worth hundreds of thousands of dollars so it’s worth getting right.

Below, you will learn how to use the City Line Strategy.

…and, importantly, why PPO Negotiations rarely works for startups.

                                                  Click to Learn the City-Line Strategy

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The Problem with Typical Dental PPO Negotiations
If you Miss the City-Line Strategy…

Many startups are convinced to spend thousands of dollars on a “negotiator”. All too often, startup dentists spend a lot of money but get no results.

For mature, established practices, PPO Negotiations are great. But as a startup you need to know about 3 major problems.

This is why the City-Line strategy can be a better option than PPO Negotiation for startups.

The Top 3 Problems with PPO Negotiations for Startups

  1. You Have No Leverage…and Nothing to Negotiate With. If you want higher fees through PPO negotiation, you need to have something with which you can negotiate. Sadly, as a startup you have nothing to negotiate with. You have no patients. You have no leverage. PPO negotiations works best when you have leverage. With the City-Line Strategy you won’t need leverage.
  2. PPO negotiations takes multiple months. You don’t have enough time before you open for proper PPO negotiations. Before negotiations start, you need a signed lease and an address. Then, at that moment, your construction may take just 3-4 months. But that’s not enough time for Proper PPO Negotiations. You cannot risk opening a startup without Negotiations being complete because…
  3. Being “In-Network” Must Be Your Goal.  This is an issue of timing. If your PPO timing doesn’t get you in-network prior to opening, you’re going to have a major problem.  With the City-Line Strategy you will be in network and you will avoid the timing catastrophe.

The Timing Catastrophe
(of Dental PPO Negotiations for Startups)

Many colleagues try opening a startup with the wrong timing. For those colleagues, their patients arrive in the startup practice…but the practice is not in-network.

This is the Timing Catastrophe.

Imagine how frustrated and confused patients will be if your team says you’re “in-network”. But you’re not. Billing statements will be a mess. Patients will be told they owe your full fee. Your front desk team will be stressed and confused at a time when your startup needs them at their best.

The dentists with a “negotiator” often pay thousands of dollars and chase the Insurance Carrier for months, still waiting for a commitment.

They wait.
And wait.

But all that waiting prevents you from being In-Network.

When a startup is not credentialed with the right timing (i.e. In-Network), the patient experience suffers a severe blow.


Your startup cannot be in-network while you’re “negotiating” until after you complete those “negotiations”.

In other words, as a startup, you are NOT in network until you agree on a FINAL fee schedule. Only then are you in-network.

The awful part of this is that you cannot control the Insurance company’s timeline of approval. Unfortunately, negotiations with an insurance carrier only extend your timeline.

This means that any startup who enters into negotiations must be extremely careful with timing.

I recommend you ignore the “negotiations” strategy altogether for a startup. Too many dentists chase this like its a mythical pot of gold under the rainbow. Your odds of wasting time while getting no results are dangerously high.

I know this, because my team of consultants and I have helped hundreds of dentists with startups, all over the country.

Chasing Dental PPO Negotiations for a startup is a bad idea.

PPO NegotiationsYou have no leverage. Your timing will be off. You’ll be out of network, frustrating your patients,

And you MUST be In-Network before you open.

Do you see the problems with PPO Negotiations for startups?

The City-Line Strategy avoids these problems.

SOLUTION: the City-Line Strategy

This may sound shocking: A Dentist on one side of the street can be paid much less…for the same procedure…on the same day…from the same insurance carrier.

Don’t miss what you just read. It could reshape your startup plans.

This is the crux of the City-Line Strategy.

You have the ability to use this strategy because you’re a startup. Few colleagues realize how many financial and personal benefits are uniquely available to startup practices. The City-Line strategy – or any of a dozen OTHER location strategies available to startups – can increase your profitability, even without PPO Negotiations.

Thankfully, none these other strategies have the negative issues related to PPO Negotiations.

BONUS: Below, I will share 3 more of another dozen strategies we use with our startup-clients that you can also consider.


Quite literally, you can be paid more for the same procedure, simply because your startup is on the other side of the road. During this stage, reimbursement fees on both sides of the City-Line can be compared, showing a simple, powerful gain in profitability. This can become a final and powerful choice in your location selection.

By doing the research at the right time, you will have higher profits, just because you chose the right side of the street.

Surprising, right?

But how depressing is it for the dentists who discover they’re paid LESS for doing the SAME procedure?

Watch the video in this article. In the video, you will see a perfect example of the City-Line Strategy. (Click this link or the click the video-image from above)

One side of the street represents being “in the city”. The other side of the street is outside the city. Same town, same population, same traffic light.

Yet one dentist is paid less.

Same procedure. Same geography. Different reimbursement rate.

When a startup practice in dentistry is planned the right way factors like these are analyzed at the right time in the planning stages.

This is important because, in a startup, you can’t go backwards. Each step must be followed properly the first time through.


  1. Your Vision Call is complete, charting the year-long process
  2. Business plan is prepared for you
  3. Demographics from Startup-specific experts are done
  4. Financing is negotiated
  5. Budgets are set
  6. Realtor introductions are made
  7. Building choices are ranked
  8. Landlord negotiations progress
  9. Free rent negotiated by an expert other than a realtor
  10. Free construction negotiated by an expert other than a realtor
  11. City-Line Strategy

At this stage, if you have 2 great locations and 2 great landlord negotiations, all of equal value, one of your most profitable tiebreakers is the City-Line Strategy.

Don’t leave this to chance!

At this stage, you have a 50/50 shot at earning hundreds of thousands of dollars MORE during your career when you’re in this position.


PPO NegotiationsDo not “start” with the City-Line Strategy.

This is a strategy that enhances your final choice. It is never smart to start your startup planning with this strategy.

Follow the 11 steps above prior to starting your City-Line strategy.

Then, if your plans have been designed properly during previous months, this process won’t cause any delays and will give you total confidence that you’re making the right choice for your startup.

How Do PPO Insurance Companies Get Away With Paying Different Fees on the Same Street?

Insurance companies are literally in the business of paying you as little as possible. That is their business model. They have lobbyists in government. Lawyers on their payroll. They’re in it to make money, not pay you. You’re just part of their business model.

In their minds, you’re no more important than a rock is to the owner of a quarry business. You’re just a cost to them.

But with the right research and the right process on your side, you will benefit from the tactics of the PPOs, not become a victim of them.

And this is how our startup clients can produce over a million dollars in their first year. They open practices they love with a practice reputation they’re proud of.

Profitable with a proven plan.

They don’t follow advice from people who haven’t opened even 1 practice in the last 5 years. These doctors work with experts who do nothing but open hundreds of startup dental practices.

3 Bonus Strategies to Benefit Your Startup:

  1. Coding strategies – Get paid 5% to 100% more on the same procedures. We teach these in the StartupMBA program for our clients and it increases profits in your first year. Same procedures, more profitable coding.
  2. Ideal Patients – target the right population BEFORE you look at real estate. Don’t even look at buildings until you understand this. Read that again. Do not look at buildings until you have this figured out. With your Ideal Patients, you can bill for procedures that get case acceptance, treatment planning a procedure mix that matches your clinical philosophy.. With a startup, you have one chance to attract your Ideal Patient.
  3. Demographics Studies – don’t fall for the expensive demographics “reports” that get pitched as online sales purchases. Doctors buy those “reports” for hundreds of dollars – sometimes thousands – and they’re told the data will help. Wrong. Piles of data do not make decisions easier. More data usually leads to more questions. This is called paralysis by analysis.Your future practice choices deserve an an analysis done by startup-specific experts, not a cheap online stack of numbers sold to you in a “report”. This is why Demographics Studies guide startup doctors with answers and strategies, customized for your practice model.

Better than PPO Negotiations|

You get one chance to open a startup the right way.
If you miss any step in the process…you don’t get to go back.

Topics like PPO Negotiations sounds so sexy. But don’t fall for them.

As you now see, the chances of significant benefits are slim. Wasted costs and the Timing Catastrophe could ruin your first year. So don’t gamble on unproven concepts.

The bad news about a startup…

There are plenty of people who are going to try and tell you how to open your startup. Even people with good intentions will try to tell you how to do this. If they’re one of those people who love giving their opinion online, yet haven’t even opened more than 1 successful startup, ignore them.

Their advice might be good for a social media post. That post makes them feel important…but if their experience is limited to just 1 startup sometime in the last 5 years, is it proven advice?

Your future practice and career deserve better than those distractions from their unproven trial-and-error ideas.

Here’s the reality…

Startup Practices are the best part of Dentistry.

When you open a startup, you get to define your reputation, even before you open.
Control is in your hands through the entire process.
Your income level is your decision.
Setting hours is in your power.
And training a team to care for patients YOUR way is one of the most rewarding experiences of the entire journey.

This is more than just a startup business.
This is about your personal and professional pride.

As a private practice owner, this is your career.
It’s your life.
This is how you will care for patients for decades.

So let’s get this right. The first time.

Follow the proven process from the day of your Vision Call until your Grand Opening and you’ll create a future you can be most proud of.

PPO Negotiations

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