Before You Drop Insurance, You Need to Know This

Let’s just be honest about what’s actually happening in dentistry right now.

Dentists already know they’re getting ripped off by insurance companies. This is not some revolutionary realization anymore.

They know what their private practice fee is. They know what the PPO fee schedule is. They know the write-offs are ridiculous. They know overhead keeps climbing while reimbursements stay flat or go down.

So when a dentist stays in-network, it’s usually not because they’re unaware of the problem. It’s because they’re terrified of the fallout.

And honestly? That’s reasonable. Because the fallout is real.

Some patients will leave. Some patients will get upset. Some patients will accuse the office of being greedy. Some patients will threaten to go somewhere else. And some actually will.

That’s the part nobody wants to talk about.

Everybody loves to talk about “freedom” and “fee-for-service” and “stop letting insurance dictate your practice.” That all sounds great. But when a doctor sits in their office and starts thinking:

• “What happens if 30 patients leave?”
• “What happens if hygiene slows down?”
• “What happens if the schedule opens up?”
• “What happens if collections dip for six months?”

That’s when the fear kicks in. And this is where the conversation gets very interesting.

Because getting out-of-network is actually easy. Any dummy can write a resignation letter. You can look up the terms of your provider agreement, send the letter, wait the required amount of time, and you’re out.

That’s not the hard part.

The hard part is understanding the risk before you do it — and mitigating the losses after the letter is written.

Table of Contents

• The Real Problem: Dentists Don’t Have the Analytics
• Most Practices Are Less Dependent Than They Think
• The Fallout Is Real
• Marketing Becomes Critical
• The Letter Isn’t the Valuable Part

The Real Problem: Dentists Don’t Have the Analytics

The hard part is the analytics. The hard part is understanding:

• How many patients may leave
• Which plans actually matter
• How much production is truly at risk
• Whether your case acceptance is strong enough
• Whether your new patient flow is healthy enough
• Whether your practice is operationally stable enough to absorb the transition

And this is where most practices are completely blind.

What’s remarkable is that dentists are paying hundreds of dollars every single month for practice management software, support contracts, cloud systems, and reporting tools — yet most offices still cannot easily pull the exact data they need to make one of the biggest business decisions of their career.

A dentist should be able to hit a button and instantly see: the office fee, the contracted fee, the write-off, the insurance associated with the patient, how many patients are tied to each insurance, how much production comes from each plan, and how much collections come from each plan.

That should be simple. But instead, most practices are trying to piece this information together manually like it’s 1997.

And without analytics, you cannot assess risk. You’re operating emotionally instead of mathematically. That’s dangerous.

RELATED VIDEO: 🎥 Should You Drop PPOs?

Most Practices Are Less Dependent Than They Think

Now here’s the really interesting thing we’ve been discovering while helping practices analyze this data: most offices are not nearly as insurance-dependent as they think they are.

That shocks dentists all the time. We’ll talk to a doctor and they’ll say, “We’re probably 50% PPO.” Then we start running the analytics and discover they’re actually closer to 65% private practice and maybe only 35% truly dependent on in-network participation.

And you know why it feels worse than it actually is? Because the discounts are so deep they emotionally dominate the practice. The write-offs are so painful that the dentist feels like insurance controls everything, even when the actual patient percentage tied to those plans is relatively small.

We’ve seen practices participating with ten different insurance plans where seven of those plans combined make up less than 10% of the patient base. Think about that — seven plans, countless write-offs, constant headaches, and together they barely move the needle in the practice.

At that point, the conversation changes. Now the dentist starts asking: “Wait… what exactly are we holding onto here?”

The Fallout Is Real

But this is also where some dentists make a mistake. They hear stories online about doctors dropping insurance and suddenly doubling profitability overnight and think, “That’s it. I’m done. I’m resigning tomorrow.”

Slow down.

Because there absolutely is fallout when you go out-of-network. And if the practice is weak operationally, that fallout can hurt.

Case acceptance becomes a huge issue. If your office already struggles getting patients to move forward with treatment while you’re in-network, what do you think is going to happen when patients suddenly have more out-of-pocket responsibility?

Let’s say a patient needs two crowns. Your contracted PPO fee is $1,000 per crown and the patient portion is manageable enough that maybe they move forward. Now you go out-of-network. Your real private practice fee is $1,600 per crown. Suddenly that patient’s investment jumps significantly — instead of owing around $1,000 total, maybe they’re closer to $2,200.

Many offices cannot even get patients to say yes at the lower fee. So what happens now?

That’s why case acceptance matters. That’s why communication matters. That’s why treatment presentation matters. If the office cannot confidently explain value, handle financial conversations, and help patients make decisions, then yes — going out-of-network becomes harder.

🎧RELATED PODCAST: Should You Stay In PPO Plans or Get Out Now?

Marketing Becomes Critical

And then there’s marketing. This is another area dentists underestimate completely.

If your practice only attracts 15 new patients per month and 80% of those patients are finding you through insurance directories, then removing yourself from those directories creates real risk. That’s just math. You now have to replace that acquisition source.

Which means:

• Marketing has to improve
• Phone handling has to improve
• Online visibility has to improve
• Reviews have to improve
• Referral systems have to improve
• The overall patient experience has to improve

This is why the practices that successfully transition out-of-network are usually not succeeding because they wrote some magical resignation letter. They succeed because they prepared the practice before making the move. They tightened up operations. They improved case acceptance. They improved new patient acquisition. They reduced attrition. They strengthened the business.

That’s what actually creates stability.

The Letter Isn’t the Valuable Part

And honestly, this is the part that makes our Get Out-of-Network Blueprint so valuable. It’s not the resignation letter. Again, any dummy can do that part.

The real value is helping the doctor finally understand the numbers:

• What is the actual exposure?
• What is the actual dependency?
• How many patients could leave while the practice still becomes more profitable?
• Which plans are truly dangerous?
• Which plans barely matter?
• Where are the weaknesses in the practice that need to be corrected first?
• And once the letter is written, how do you mitigate the fallout that comes afterward?

Because once the analytics become clear, the fear starts getting replaced with strategy. And that’s the real goal.

Not emotion. Not reacting out of frustration. Not waking up angry after looking at another adjustment report.

The goal is making an informed business decision backed by real numbers. Because getting out-of-network is easy. Understanding the fallout — and preparing your practice to absorb and mitigate it profitably — is the hard part.

For any additional questions and information, please call 800-640-1140 or go to MGEonline.com