Out-of-network

Going out-of-network means the practice has no contract with a given plan and is free to charge its full fee, rather than the plan's discounted allowed amount. A patient whose plan has out-of-network benefits may still receive partial reimbursement directly from their insurer, but the dentist bills the patient the full fee and lets the patient handle their own claim, rather than accepting a contracted write-off.

This is the destination for most of the phased strategy Ryan teaches around PPOs: stay in-network long enough to build a patient base and a reputation, then drop the worst-paying plans first, renegotiate the ones worth keeping, and move toward a practice increasingly built on fee-for-service and out-of-network patients as the reputation and referral engine strengthen. It is rarely an all-or-nothing leap for an established practice with a full schedule.

The financial case for going out-of-network on a given plan is straightforward arithmetic: the practice can absorb losing up to exactly the plan's write-off percentage in patients and land exactly where it started, and real-world attrition after a well-communicated transition tends to land well below that break-even number.