Skip to content

Want Higher PPO Reimbursements Without the Negotiation Headache? Start With This Strategy

Want Higher PPO Reimbursements Without the Negotiation Headache? Start With This Strategy

If you’re preparing to open your own dental practice, there’s a lot of excitement—and let’s be honest—a fair amount of noise out there. One of the loudest? That you have to pay thousands for PPO negotiations to secure higher reimbursement rates.

Let’s hit pause on that.

I’m here to tell you there’s a better way for startups. It’s called the City-Line Strategy, and if used correctly, it can significantly increase your PPO reimbursements—without the delays, stress, or costs of traditional PPO negotiation.

Why PPO Negotiations Don’t Work for Startups

There’s a time and place for negotiating with insurance companies. But for a startup? It’s usually not a winning move. Here’s why:

  • You have no leverage. No patients, no collections history—nothing to negotiate with.

  • You don’t have time. Proper negotiations can take months. Most startups don’t have that runway between lease signing and opening day.

  • You need to be in-network before you open. If you’re still in negotiation mode when you open, you’re out-of-network—and your first patient interactions are going to be billing disasters.

We’ve seen it too many times. A doctor hires a negotiator, spends thousands, then ends up opening their doors while still waiting on insurance approvals. The result? Confused patients, frustrated teams, and a first impression you can’t afford to botch.

The City-Line Strategy: A Smarter Alternative

Here’s what most dentists don’t realize: reimbursement rates can vary dramatically just by being on one side of a city boundary line versus the other.

Literally—same day, same procedure, same insurance carrier. But because of how insurance companies map their reimbursement regions, one side of the street can be more profitable than the other.

As a startup, you have a one-time opportunity to choose the most strategic location possible. That’s where the City-Line Strategy comes in. It’s not about chasing better rates later—it’s about planning for them from the beginning.

How It Works

  • During your location selection phase, your consultant evaluates two comparable properties

  • With your business plan, budget, and financing lined up, you compare reimbursement rates by address

  • You choose the location with higher reimbursements built into your ZIP code

  • You enter contracts already in-network, already aligned with the highest-earning side of the line

This strategy requires planning. You can’t just stumble into it. It’s a tie-breaking tool we use after a practice has followed the proper sequence of planning steps.

The 11 Planning Steps Before You Apply City-Line Strategy

  1. Vision Call

  2. Business Plan

  3. Startup-specific Demographics

  4. Financing Negotiated

  5. Budget Finalized

  6. Realtor Introductions

  7. Building Options Ranked

  8. Landlord Negotiations

  9. Free Rent Negotiated

  10. Free Construction Negotiated

  11. City-Line Strategy Implemented

When you do this the right way, City-Line becomes a tiebreaker that can be worth hundreds of thousands of dollars over the lifetime of your practice.

Quick Recap: The Top Reasons PPO Negotiations Fail in Startups

  • No leverage

  • Not enough time before opening

  • Missed in-network credentialing by Day 1

  • Stressful patient experiences due to billing issues

  • Delays from insurance carriers you can’t control

And the Benefits of the City-Line Strategy

  • Get in-network on time

  • Avoid costly negotiation delays

  • Choose locations based on actual PPO reimbursement data

  • Increase profits without changing your procedures

  • Start strong with a lower-stress, higher-yield setup

More Smart Startup Strategies Worth Considering

Beyond City-Line, here are three additional strategies we teach clients to boost early success:

  • Coding Optimization – Get paid 5–100% more for the same procedures with strategic billing

  • Ideal Patient Targeting – Match your clinical philosophy to a patient base that drives case acceptance

  • Startup-Specific Demographic Studies – Skip the generic reports and use actionable analysis built for startups

Final Thoughts: This Isn’t Just About PPOs

Opening a startup isn’t about being “in business.” It’s about launching a business that works—strategically, sustainably, and profitably. Your reputation, income, and freedom all ride on how well you plan your startup.

You only get one shot at doing it right. So skip the distractions. Avoid the myth of the magic PPO negotiator. And use tools like City-Line to give your practice a smarter start.

If you're serious about building a practice you can be proud of—from day one—let’s talk. Our team has helped hundreds of startup dentists do it right the first time. You deserve that too.

Learn more about practice location strategy in the bestselling book “Choosing the Right Practice Location.” Get your free copy at www.idealpractices.com/free

Here’s to the smarter path forward. Let’s make it count.