February 04, 2026
Escaping the PPO Trap: How to Become An Out-of-Network Dentist
As a medical provider, dentists work within the healthcare system. Unfortunately, the healthcare system doesn't always work for them. Modern dentistry is weighed down by the complications of dental insurance PPOs and shrinking reimbursement rates. Today we're talking about the reality of being an in-network dentist, and how to strategically position your practice so you are no longer dependent on PPOs to survive.
The Realities of Being an In-Network Dentist
While dental PPO plans can bring patients in the door, being an in-network dentist does not always equate to profitable scheduling. That's because the system is built for volume, not value — which directly impacts dental practice profitability. In reality, being in-network means earning less and becoming entangled in a system that is designed to keep you reliant.
Working Harder, Earning Less
PPO reimbursements continue to shrink while the cost of running a practice keeps climbing. Payroll, supplies, lab fees, rent, and software are not getting cheaper.
The result is a painful contradiction: Production increases, but margins don't. Dental practices get busier without getting profitable. When fees are capped, volume becomes the only lever left to pull. So you get more patients and fuller schedules, but also longer days, less control and less revenue per hour.
After a while, being "busy" starts to feel less like success and more like survival.
Trapped in PPO Dependency
When PPO volume is the primary source of demand, growth becomes a dependency — not a strategy. By relying on PPOs to draw patients to the practice, you surrender pricing, predictability, and patient selection. And it's a compounding problem. The busier the practice gets, the harder it feels to change. Especially when the majority of your patients are wrapped up in the PPO machine.
It can feel like there's no time to step back and breathe, let alone align the team, refine messaging, or build profitable demand. And so what happens? The practice becomes trapped serving an insurance-driven dentistry model that ultimately limits flexibility and control.
In-Network vs Out-of-Network Dentistry
When dental practices start questioning their relationship with PPOs, the conversation often gets oversimplified.
"Insurance is bad."
"Out-of-network is better."
"Fee for service is freedom."
True as all of those may ultimately be, the reality is more nuanced than that. Being an in-network dentist is a business model. And it looks a lot different than a fee-for-service or independent model. Let's take a closer look.
In-Network Dentistry (PPO-Driven Model)
Fees are predetermined by insurance contracts. This can provide some semblance of consistency for the practice, but it simultaneously limits flexibility and ownership decisions, locking in prices regardless of case complexity or business cost increases.
Profitability depends on volume. This often means shorter appointments, tighter schedules, and less margin for error.
Growth tends to come from doing more, not necessarily doing better.
Patient acquisition is largely insurance-driven. This is how and why many practices come to rely on their relationships with insurance providers — it's where patients come from. But this relationship also reduces control over who chooses the practice and why.
Marketing plays a secondary role, since demand is largely dictated by plan participation. Lower spend reduces out-of-pocket expenses but also reduces reach, leads, and conversion, weakening the investment and return.
For many practices, this model keeps chairs full, but it also keeps pressure high and eliminates control and flexibility.
Out-of-Network Dentistry (Fee-for-Service Model)
Fees are set by the practice with a pricing schedule that reflects time, expertise, and quality of care.
Revenue is driven by value, not volume, which helps support longer appointments and more intentional scheduling.
Patients come to the practice based on deliberate choice, seeking a provider they trust — not just one who takes their insurance for an annual cleaning.
Marketing becomes a necessary investment, helping clearly communicate who the practice is and what it stands for.
Practice growth is built through positioning, messaging, and patient experience — which are all optimized around the kinds of patients and cases the dentist wants most.
This model offers more control, but it also demands more clarity and consistency.
Why "Just Dropping PPOs" Doesn't Work
Recognizing the problem is one thing. Acting on it is another. Even knowing the math and feeling the squeeze, going out of network feels like a pretty giant leap of faith. PPOs are often the engine behind patient flow and revenue, and turning that off overnight obviously risks putting the whole practice in a tailspin, especially if there is not a plan to replace the patients lost in the exit.
The most successful transitions don't start with dropping plans, but rather with preparation and groundwork.
Before You Drop, Build a Fee-for-Service Foundation
Before you make any move, let's be clear that this isn't just a pricing tweak or New Year's resolution. Transitioning away from dental PPOs and toward a fee-for-service dental practice is ultimately a shift in business model. The same way you wouldn't casually consider adding a location or bringing on a partner, you shouldn't approach PPO participation changes without a plan in place.
So what's that plan look like in real life?
Let's take a look.
1. Establish a clear practice ethos.
Before any insurance participation changes, the practice needs internal clarity. That starts with putting the basics in writing:
What the practice believes about care
How treatment decisions are made
Why the practice exists
What makes your team and offerings different in your marketplace
The point of this alignment is to begin supporting fee-for-service positioning without relying on insurance participation. To do this effectively, you'll need to land on a clear answer to why patients choose the practice beyond "we take your plan." This gives you and your team a constant position and shared mission and messaging.
2. Train teams on consistent language, call handling, and patient education.
Once the message is clear, it has to be reinforced. Confidence comes from repetition. When everyone understands the mission the same way, they can explain the practice the same way, and patient conversations feel steady instead of defensive. Every patient touchpoint should feature the same messaging.
Draft a simple, repeatable script your team can use to handle the insurance conversation the same way every time. It should clearly explain why you're changing the relationship: insurance companies are increasingly limiting how you diagnose, recommend, and deliver care.
Phone conversations
Letter to existing patients
Chairside explanations
Financial discussions
Web inquiries
It can usually be boiled down to a short sentence or two clearly outlining your message to patients.
"Main Street Dental is now an independent provider, which means insurance no longer sets limits on how we treat. As plans have added more hurdles and restrictions, we made this change to protect the quality of your care. We'll still help you use any benefits you have, but insurance won't determine your treatment recommendations — Dr. Smith does."
3. Activate dental marketing strategies that generate demand outside of insurance.
Marketing your practice helps take back control of some of the pipeline that, until now, was coming almost exclusively from insurance. Marketing gives you a chance to teach your local market who you are, what kind of care you provide, and why someone should choose the practice.
Readiness Comes Before Action
Every practice has a different relationship with PPOs and their own payer mix to consider. Some are quietly subsidizing plans they've outgrown. Some feel constant pressure but can't pinpoint where it's coming from. Others are closer to being ready to transition out of network than they realize — but don't yet have clarity on what would actually change if they stepped out of network or where to start.
Before any PPO decision is made, practice leaders need a clear view of how insurance participation is hurting your brand, affecting patient behavior, scheduling, revenue per visit, and team confidence today. Without that level of visibility, even a well-intentioned exit can create instability.
Escaping the PPO trap isn't about dropping plans and making a run for it. Start by understanding your dependency on them — and deciding deliberately how to change it.
To help practices evaluate their team's readiness, we created a short Self-Assessment that maps where PPO pressure shows up today and what needs to be built before any considering a network change. Click here to download your free copy! If you're ready to explore what your practice might look like shifting out of network and going fee for service, get in touch any time.
