During my first 19 years of practicing dentistry, there was usually a third party in the room. It was always near and an obvious mood or psyche next to me and the patient. I’m not referring to a physical person, such as a spouse, parent, or caretaker, but rather a presence.
Dental insurance: the unseen guest in every appointment
That spiritual being was called dental insurance, and it stood in the corner of the room with its arms folded, always watching and judging, shaking its head at non-covered services, annual maximums, and agreeing to downgrades, declines, delays, yearly maximums, and other barriers to treatment.
Dental insurance can be a major buzzkill. You know the ones I’m talking about, the ones where you walk into a party and get stuck talking to someone who is being a pessimistic downer; they may have bad breath, or spill their drink on you, and are trying to get in between you and your dance partner.
For years, dental insurance benefits were an integral part of my practice, often featured in nearly every discussion with patients. Now, for me, that “Negative Nancy” atmosphere has gone. It left the building a year and a half ago, as my practice went fully out-of-network (OON). I am free to dance the way I want to dance and with whom I want to dance.
Meet the new life of the party: Membership plans
Instead, a new, hip, fresh, and different kind of third party has taken its place. It is but a companion that says the patient's first name and says hi. Nods their head in agreement, welcomes the patient to come in and address their treatment needs, and tries to get them to dance with your partner. It's a much more positive experience. This party is called a membership plan, and they are way more fun to party with. Everyone is invited to join the club and dance the night away.
This sounds a lot more fun. Right. Being tangled up in a web of insurance networks is not. And if you want to be free from insurance, you have to do it strategically. One of the most essential parts of the strategy is to offer an alternative to the Preferred Provider Organization (PPO) plan in the form of a membership plan to patients who have:
- lost their insurance benefits;
- switched jobs; or
- decided to drop their insurance or retired.
Or, get this: They never had insurance, and now they do. Even better is when they choose not to renew their insurance and join your plan.
Patient connection is your competitive edge out of network
You need to build excellent relationships with patients so they get to know, like, and trust you and won’t want to leave when you go out of network. Some may leave but then return because they trust you and the quality of care you provide.
Establishing these connections with your patients is crucial for the out-of-network process. When you treat them like a person and not just a patient, they will not want to leave. If you struggle with conversing with patients, consider watching peers, hiring coaches, or taking courses to improve your ability to communicate effectively. There are many resources available to hone this skill.
I was more introverted and a bit socially awkward; fortunately, I became more effective at articulating treatment and maximizing my time with patients as I gained more experience and confidence in my abilities.
It is best to have a membership plan in place before you go out of network. I recommend setting it up at least three to six months in advance. Test it to ensure it is up and working correctly and that the team is on board. You will find it much more challenging to go out of network without having a plan in place, and it's best to have it as a pre-season strategy rather than something you have to rush to create mid-season when it's already late. Better late than never, but the sooner, the better.
How to go out of network with dental insurance, step by step
Going out of network means your practice is no longer bound by a carrier's contracted fee schedule, so you set your own fees. Patients with PPO coverage can usually still use their out-of-network benefits. Most practices follow these steps:
- Review your payer mix. Rank each PPO by patient volume and write-off rate, and plan to leave the lowest-paying plans first.
- Launch your membership plan first. Set it up three to six months before your exit date so patients who pay for their own care have an option from day one.
- Read each contract's termination terms. Most require written notice, often 60 to 90 days, sent the way the contract specifies.
- Tell patients early. Send a letter at least 60 days before the exit date explaining that they can keep seeing you, how out-of-network benefits work, and what your membership plan includes.
- Set your financial policies. Decide whether you will file claims as a courtesy, collect at the time of service, or accept assignment of benefits.
- Train the front desk. Give the team a short script for "Are you still in network?" and a one-sentence explanation of the membership plan.
- Track retention. Watch active patients, reappointment rates, and plan enrollment for six to twelve months after each exit.
For a deeper plan, including which PPOs to drop first, see the PPO playbook.
Go out of network with a membership plan in place
Don’t let the fear of losing patients stop you from building the practice you envisioned. You shouldn’t let insurance companies dictate how you treat your patients—or whether you can treat them at all.
Instead, give patients a better option with an in-house membership plan and partner with a third-party provider that supports your philosophy of care. Help patients say yes to treatment—not because insurance allows it, but because it’s the right thing to do.
Dental problems rarely get better on their own; they get worse and more expensive. So don’t let insurance be the crutch that holds your practice or your patients back.
Ditch the buzz kills. Lead the dance.
