3 key steps for becoming an out-of-network dentist

After years of being in-network with dental insurance companies, some dental business owners begin exploring going out of network. But like anything, there’s a right way and a wrong way to accomplish it. This article shares 3 proven steps for going out of network, including insights from our experts at DCS.

Many dentists decide to leave their in-network agreement with dental insurance companies because they want more control over their dental business. Becker’s Dental Review analyzed a 2023 poll by the ADA Health Policy Institute that shows 21% of dentists plan to drop out of at least one dental insurance network within the next three months.

Those poll responses leave one wondering: Why go out-of-network? A few reasons in an article by Radiant Dental stood out to us:

• Compromised quality of care. Reduced fees imposed by dental insurance companies often affect the care dentists give. With smaller streams of revenue, dentists are sometimes forced to cut corners, leading to rushed appointments, fewer treatment options, and even compromised materials or techniques.
• Administrative burden. Claim submissions, follow-ups, and appeals are all part of being in-network with dental insurance. The paperwork and tasks associated with it are time-consuming, tedious, and a stress on your team.

And the reason that stood out most?

• Financial strain on dentists. With reduced fees, dentists struggle to cover overhead expenses, which prevents them from investing in advanced technology, continuing education for themselves and their team, and overall practice growth.

At DCS, we work with dental businesses both in and out-of-network with insurance companies, so we understand the pros and cons of both options. We’ve seen how deciding to go out of network affects more than just the dental business owner — it impacts the team and patients, too. 

Keep reading for our 3 key tips for preparing to become an out-of-network dentists, plus insights from our experts at DCS who have either gone through the process themselves or witnessed our client-partners going through it. Many of our experts have first-hand experience with the out-of-network process. Their insights come after our proven steps, so be sure to read to the end!

Key takeaways on the basics of becoming an out-of-network dentist

• Even out-of-network dentists can accept insurance coverage from patients
• Communication with both the dental team and patients is crucial when transitioning to out-of-network
• A dentist should always consult their lawyer if they have questions about their contract with an insurance company

What does “going out of network” with dental insurance companies mean?

Being in-network with an insurance payer can be defined as being an approved provider for members of a health insurance plan. Dentists become an approved provider through the credentialing process — signing a contract that accepts the terms for treating their members. 

Going out of network with insurance means a dentist isn’t bound by a contract with patients’ insurance plans, so the dentist can charge their full standard practice fees for services to patients. 

Patients’ insurance plans will cover only a percentage of the fee, and dentists can then bill the patient for the difference by filing their claim as a courtesy. The big appeal here is that either way, fees are not being dictated by insurance companies. 

Read more about the pros and cons of in-network vs out-of-network here. 

Our client-partners tell us that DCS services and solutions are transformative to both in-network and out-of-network dentists. Our automated patient billing is a great option for out-of-network dentists needing advanced technology to collect from patients. 

A decision to go out of network has consequences, though, so let’s look at 3 crucial steps for becoming an out-of-network dentist the right way: 

Step #1: Consider the insurance fees vs the fees you wish to provide

The first thing every out-of-network dentist must do is determine what their fees will be. 

Compare your desired fee with the allowed contracted fee to determine which works best for your practice. Research what other dentists in your area charge to see if your fees are similar — you don’t want to be too low or too high compared to the market.

It’s also a smart idea to research the median household income of the area your practice is in, so you can serve your community appropriately.

Important: You can still accept patient’s insurance if you go out-of-network

Remember that even if you’re out-of-network, you can still accept dental insurance coverage from patients. Plenty of dental practices will file insurance claims as a courtesy to patients, while still charging their full fee. Then insurance will reimburse the patient, unlike in-network dentists, who collect the insurance reimbursement. 

Ocean Breeze Prosethedontics explains the fee-for-service business model from the patient's point of view: 

“Choosing an out-of-network practitioner means you will have to pay for the services at the time of treatment. This is what we call a ‘fee-for-service office’. Most fee-for-service offices work insurance, but you will typically pay for the services at the time of treatment.”

What can be tricky about determining your fees is accurately estimating what a patient’s insurance will cover for the treatment presentation. 

Insurance companies have what they call fee caps, which control the fee a dentist allowed to charge a patient for a non-covered service if they’re in-network. 

As an out-of-network provider, you’re not limited by insurer fee caps, but you also won’t know what those fee caps are. When you’re presenting treatment and giving cost estimates, you won’t truly know how much a patient’s insurance will reimburse them. 

For example, you can charge $150 for a filling, and insurance will cover 80% — but they won’t cover 80% of your $150 fee. They'll cover 80% of whatever they call a reasonable fee, which may be $100. Again: as an out-of-network provider, you won’t have access to their fee schedule, so you won’t be able to guarantee an accurate estimate.

Be sure to explain this to your patients so they aren’t surprised by a price discrepancy when they receive their bills. And of course, if their costs are higher than expected, you can always offer payment plan options through automated patient billing solutions. 

Step #2: Review your contract with the dental insurance company for the termination clause

Next, as the dentist, you need to review the in-network contract you’ve signed.

Read through the documentation and familiarize yourself with the requirements you need to fulfill to leave the network. To remain legally compliant and expedite the process, make sure you follow the contract guidelines exactly.

In almost all cases, you will have to give written notice to the insurance company, and most insurance companies require notification 30 to 90 days in advance.    

When it comes to dealing with insurance companies, it’s best to cover all of your bases.

Your contract should specify where to send the notice letter, but call the company’s provider relations department to confirm and request details for their current preferred method — an email address, a fax number, or a mailing address to send your letter to.

If you’re sending your termination notification letter through the postal service, we recommend using certified mail, so you will have proof of when the insurance company received it.

After it’s been received, request a written or emailed confirmation of the date you will be out-of-network. 

You may need to call in extra resources for support during this transition. You might turn to your lawyer for advice if you have questions about your in-network contracts, for example. For first-hand insights on going out of network, our client-partners can always turn to their account representative in our DCS Knowledge Network.

Here is a valuable resource from the ADA for terminating your network contract with dental insurance companies. It includes best practices, tips for going out of network, and even what to expect once you’re out-of-network.

One of our favorite tips from this resource: “Send a letter to your patients explaining the change.”

Which brings us to our last step…

Step #3: Tell your team and your dental patients about becoming an out-of-network dentist

The first group that needs to know you’re going out-of-network is your dental team. This change will affect their workflows, and they’ll be the ones answering patients’ questions. 

Next, you’ll want to notify your patients, and some insurance contracts state that you must inform them. As always with insurance companies, cover all your bases. Make sure you document how and when each patient was informed.

It’s crucial to inform your patients well in advance of the change — ideally 9 months before, and at least 6 months before. Be transparent and strategic about this process. The ADA recommends both mailing and emailing a notification letter to your patients, and we also suggest discussing it face-to-face as they come in for appointments in the interim.

Related: Happy patients, happy practice: 3 ways to improve your dental patient experience

During a patient’s visit, inform them face-to-face that your practice will no longer be in-network with their insurance carrier. It might take some team planning, role-playing, and time, but this is the best way to retain patients because you can answer their questions and allay their fears. 

Be sure to explain that you can still accept their insurance coverage and file a claim for them, but you’ll be charging your full fee up front, and can’t guarantee an accurate out-of-pocket estimate. It’s better to be transparent, even if you’re worried it will scare patients off.

Brace yourself: When you go out of network, you will gain new patients, but it;s likely you will also lose at least a few. Putting in extra effort to retain patients will go a long way if you decide to go out-of -network. Your extra care and attention remind them why your dental practice is more valuable than others.

What our DCS Knowledge Network wishes dentists knew about preparing to becoming out of network

Our DCS Knowledge Network is our ‘fleet’ of experts at DCS. We have over 100 revenue cycle management (RCM) professionals who specialize in the dental revenue cycle, bringing years of experience to getting your dental business paid quickly and accurately.

We asked our experts what they wished dental professionals knew about going out-of-network. Here are the three tips you’ll find most valuable: 

Tip #1: Test the waters.

 “Send a letter of their intent to see how the patients react. This way you can prepare for the reaction rather than be on the defensive.”

Tip  #2: Get ready for questions and conversations.

“The front office team should be prepared with verbiage during the transition period from in-network to out-of-network.

There are offices that do all the right preparations with research and numbers, but then are unprepared for the conversations with the patients who are used to having in-network benefits. In some cases, the right verbiage can prevent losing patients.”

Tip #3: Anticipate your losses

“Be aware of how many patients are with the carrier, and be prepared to possibly lose those patients. Some plans pay great for i n-network, and then for out-of-network, they pay off of a low fee schedule vs UCR.”

Going out-of-network is a significant change for your team, your patients, and your practice. For your continued success, prepare everyone by following these steps and the recommendations from the ADA, your lawyer, and our expert RCM team. 

Become an out-of-network dentist the smart way

Here are 3 key steps to becoming an out-of-network dentist: 

• Step #1: Consider the insurance fees vs the fees you wish to provide, and research your local market and competitors
• Step #2: Review the termination clause in your contract with the dental insurance company
• Step #3: Tell your team and your patients about leaving the insurance network

Our favorite tip from our DCS Knowledge Network is to provide your team with all the information, training, and time they need to explain to patients that you’re leaving their insurance network. 

At DCS, we love administrative teams! They’re who we typically work directly with, and we believe they deserve to be set up for success when substantial changes like going out-of-network impact their work and the patient experience. 

Whether you’re in-network or out-of-network, we’re here to help. Explore our end-to-end revenue cycle management solutions, and join us to access our DCS Knowledge Network. Book a free 30-minute consultation today.