When Should a Dentist NOT Go Out of Network?

While reducing insurance dependence is an achievable goal for most dental practices, the reality is that going out of network isn't appropriate for every dentist at every stage of their career. Understanding when to wait—and why—can save your practice from costly mistakes and frustration.

The Foundation Must Be Strong

Many dentists dream of breaking free from PPO plans and building a thriving, insurance-independent practice. However, success requires more than just a decision and a letter to your patients. Going out of network requires a strong foundation across multiple business dimensions.

When your practice operates within insurance networks, certain things are easier. You don't need sophisticated phone communication skills because free or low-cost services drive patient acquisition. You don't need advanced clinical skills, cutting-edge technology, or a deeply engaged team. Insurance coverage removes many barriers to patient acceptance, even if it comes with significant reimbursement challenges.

When you operate out of network, everything changes. You must excel in every area: communication, technology, team dynamics, clinical quality, and patient experience. These are not optional enhancements—they're essential foundations for survival.

The 5 Reasons a Dentist Should NOT Go Out of Network

Before making this critical decision, honestly assess whether your practice exhibits any of these characteristics:

1. Your Practice is Transaction-Based

A transaction-based practice views patients as individual encounters rather than relationships. Patients don't know your name. You don't know theirs. They come in for a specific problem—a toothache, a cleaning, a crown—and never return unless they have another problem.

Think of it like taking a vintage 1965 Porsche 911 to a "quickie oil change" shop instead of a specialist restoration center. Transaction-based practices are that quickie shop: convenient, cheap, and completely forgettable. Patients choose based solely on price and convenience.

The Test: Can you name five school teachers in your patient list without looking at your records? How about five business owners? Five first responders? If you can't, your practice is more transactional than you might believe.

The solution isn't permanent—you can transition toward a relationship-driven model. Start by learning patient names before their appointments. Conduct brief interviews during new patient exams to build connection and understanding. Ask questions about their lives, their goals, their concerns about dentistry. These small steps shift the dynamic from transaction to relationship.

But if your practice is currently transaction-based, wait before going out of network. Build the relationship foundation first.

2. You Have No Clear Reasons for Patients to Choose You

In a PPO network, patients have a simple reason to come: you're covered by their insurance plan. When you go out of network, that reason disappears. You must provide compelling alternatives.

What reasons might patients choose your practice instead of competing practices?

• Technology: Many patients associate advanced technology with superior care. Digital imaging, CAD/CAM, intraoral cameras, and other innovations give patients confidence in your approach.
• Range of Services: A one-stop-shop for diverse dental needs—from routine cleanings to cosmetic dentistry, orthodontics, or implants—makes your practice more valuable to patients.
• Specialized Expertise: Perhaps you offer biological or holistic dentistry, advanced cosmetic work, or other specialized services.
• Relationship-Driven Care: This is the strongest differentiator. When patients feel known, cared for, and valued, they choose to stay.
• Convenience: While we don't recommend overextending with evening/weekend hours at the expense of work-life balance, convenient scheduling can be a factor.

Step back objectively: What compelling reasons would a patient choose you beyond "my insurance covers it"? If you can't articulate clear differentiators, develop them before going out of network.

3. You Lack Communication Skills to Discuss the Transition

One of the most common mistakes practices make is sending a letter announcing their network status change. This is the worst possible approach.

When you go out of network, you must personally communicate with patients—face to face when possible, or at minimum through direct conversation. This requires genuine communication skills from you and your team. You need to:

• Explain your reasons for the change
• Address patient concerns honestly
• Reassure them about quality of care
• Discuss fee structures and payment options
• Answer difficult questions without defensiveness

If you or your team lack these communication skills, or worse, if you're unwilling to engage in these conversations, stay in network. The letter approach creates resentment and patient loss that's difficult to recover from.

The good news: communication skills can be developed through training and coaching. But you must be willing to invest in this development before making the transition.

4. You Have No Marketing Strategy in Place

When you go out of network, you will lose some patients. This is inevitable and expected. However, you cannot afford to lose patients without a plan to replace them.

Before going out of network, you must have a marketing strategy that attracts new patients who choose you for reasons other than insurance coverage. This might include:

• Digital marketing that positions you as a specialist in your niche
• Content marketing that builds trust and authority
• Local SEO to capture patients searching for your services
• Relationship marketing through patient referrals
• Direct response marketing to your current patient base

Without this strategy in place, the patients you lose will simply go to other practices. Your revenue will drop, and you'll lack the patient volume to sustain your business.

Develop a comprehensive marketing plan before making the transition. Work with a marketing expert who understands dental practices and can build a system to replace the patient flow you lose from insurance networks.

5. You Don't Believe It Will Work

Perhaps the most critical factor is internal belief. If you fundamentally don't believe this transition is possible for your practice, don't attempt it.

Henry Ford famously said: "Believe you can, or believe you can't—either way, you're right." This applies directly to going out of network.

If you don't genuinely believe this strategy will work, your team will sense that doubt. Your communication with patients will lack conviction. Your marketing efforts will feel half-hearted. Patients will perceive your uncertainty and make different choices.

Conversely, dentists who have successfully gone out of network share a fundamental belief: "Whatever I lose, I can replace." This abundance mindset—combined with strategic action—creates reality.

The Four-Minute Mile Effect: Until 1954, sports scientists believed no human could run a mile in under four minutes. It was physiologically impossible, or so they thought. Then Roger Bannister ran 3:59.4 on May 8, 1954, proving it possible. Within two months, three other runners broke the four-minute barrier. What changed? Not human physiology, but belief about what was possible. Over 400 dental practices in all 50 states have successfully gone out of network with proper coaching and strategy. If it's been done, it must be possible. But you must believe it.

Building the Right Foundation

If your practice exhibits one or more of these five characteristics, this doesn't mean you can never go out of network. It means now is not the right time. Instead, focus on building the foundations that will make success possible:

• Strengthen relationships: Implement systems to know your patients, remember their names, understand their preferences and concerns.
• Develop differentiators: Invest in technology, training, or specialized services that give patients compelling reasons to choose you.
• Build communication capacity: Train yourself and your team to have meaningful conversations about practice changes and patient needs.
• Create marketing infrastructure: Develop the systems, skills, and budgets needed to attract new patients consistently.
• Cultivate belief: Read success stories, join communities of dentists who have made the transition, develop an abundance mindset about your practice's potential.

Each of these foundational elements makes the transition easier and increases the likelihood of success. They're not busywork—they're essential infrastructure for a thriving, insurance-independent practice.

Your Practice Snapshot

Take a moment for honest self-reflection. Which of these five areas might need development in your practice?

Rather than viewing this as discouraging, consider it a roadmap. Each area represents an opportunity to strengthen your practice, improve patient outcomes, and increase profitability—regardless of your network status. A practice that excels in these five areas will thrive whether it operates in-network, out-of-network, or some combination.

The practices that successfully go out of network aren't the lucky ones. They're the ones that built the right foundation first and made the transition from a position of strength.

Reviewed by

Naren Arulrajah

CEO & Founder, Ekwa Marketing

Naren Arulrajah is the CEO and Founder of Ekwa Marketing, a 300-person dental marketing agency that has helped hundreds of practices grow through SEO, reputation management, and digital strategy. A published author of three books on dental marketing, contributor to Dentistry IQ, co-host of the Thriving Dentist Show and the Less Insurance Dependence Podcast, and a member of the Academy of Dental Management Consultants. He has spent 19 years focused exclusively on helping dental practices succeed online.