Free calculator
Out-of-Network Break-Even Calculator
How many of a plan's patients could you lose by going out of network and still collect the same production?
Leaving a PPO network does not mean turning its patients away. The contract ends — and the fee schedule that forced the write-off ends with it — while the patients who stay pay your own office fee instead of the plan's. Some will leave. The question is how many you could lose before you were worse off.
The answer is a single line of arithmetic: if a plan pays you sixty-five percent of your office fee, thirty-five percent of its patients could walk away and the remaining sixty-five percent, paying your office fee, would produce what all of them produced before.
The numbers already filled in belong to an example practice — 400 patients on the plan · the plan's fees at 65% of your office fees. They are there so you can see the calculator work before you type anything; they are not benchmarks. Replace them with your own.
Everything is calculated in your browser. Nothing you enter is sent to us or stored.
Your break-even
Change any number and press Calculate. Reset brings the example practice back.
Your break-even
| Share of the plan's patients you could lose | |
| Patients you could lose | |
| Patients who would need to stay, paying your office fee |
Before the admin savings — the insurance-related administrative cost you would stop carrying makes the real break-even a little higher.
See the break-even for every plan you take
PPO Inspector runs it per plan from your own fee schedules, then the what-if for leaving the worst plans first. Free for your first hundred days, with the other six tools.
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What fixes this
PPO Inspector runs this calculation for every plan you take, from the fee schedules you enter, and then goes further: the what-if per plan and across the practice, including the insurance-related administrative cost you would stop carrying — so you can leave the worst plans first and watch what happens before you continue.
In the first practice on Profit Smiles, monthly production was up $20,000 six months after dropping unprofitable insurance plans.
Results shown are from one practice following this protocol. Individual results may vary.
How this is calculated
- Patients you can lose = patients on the plan × (1 − the plan's fee as a share of your office fee). At 65%, that is 35% of the plan's patients — 140 of 400. Rounded down to a whole patient.
- It is a production break-even: the patients who stay pay your office fee, and together they produce what the whole group produced at the plan's fees.
- Two things it leaves out, both in your favour: the insurance-related administrative cost you would stop carrying, and any new patients who arrive because you have chairs free. The real break-even is a little higher than the number shown.
- Going out of network is not refusing insurance patients. You still welcome them and still file their claims; the plan pays its out-of-network benefit and the patient pays the balance up to your office fee.
- Daily figures divide the annual figure by 365. The five-year line multiplies by five at today's numbers — no growth, no inflation, no change assumed.
This is arithmetic on the numbers you enter — an estimate, not a forecast, and not advice about your practice.
The other calculators: PPO write-offs · Treatment acceptance · Membership plan revenue · Patient attrition · Supply costs — or all of them.
See the same numbers on your own dashboard — free for a hundred days.
The protocol records your practice's baseline on day one, and every tool shows its dollar impact against it. No credit card, nothing to cancel.
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