# Going Out of Network: The 90-Day Plan, the Patient Letter and the Front-Desk Scripts

> The 90-day plan for leaving a PPO: team training at T-90, the patient letter at T-60, the conversations and scripts at T-30, and what to track after day one.

- Author: Ryan Smith, DDS
- Published: 2026-08-25
- Category: Practice Management & Profitability
- Canonical: https://ryansmithdds.com/out-of-network-transition-plan

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> **Key takeaways**
> - Going out of network is a project, not an announcement. The practices that do it well run a 90-day sequence: train the team, then send the letter, then have the conversations, then flip the switch.
> - The letter and the front-desk scripts are templates to adapt, not scripts to read verbatim. The team needs to sound like themselves.
> - You keep filing claims as a courtesy after you drop a plan; the patient's insurer reimburses the patient directly, usually at a lower rate than in-network, and patients should hear that from you before they see it on a statement.
> - Pre-schedule recare and start weekly tracking before day one, not after. The dip you catch in week two is a conversation; the dip you notice in month three is a crisis.

Every dentist I've talked out of staying in a bad PPO contract has the same fear: that the day they go out of network, the schedule empties out. It doesn't happen that way if you treat the transition like a project with a timeline, instead of a decision you make on a Tuesday and announce on a Wednesday.

I've done this in my own practices more than once, at different scales, with different results depending entirely on how much groundwork went in first. One office dropped its lowest-paying plan and lost about 8% of that plan's patients; collections were higher within six months. Another dropped a plan covering roughly 600 patients and kept well over 90% of them. I've also watched a dentist drop two major plans at once, with no team training first, and have to backtrack. The difference wasn't the plan. It was the plan for leaving the plan.

This article assumes you've already decided to go. If you haven't run the numbers yet, do that first: the [PPO write-off analysis](/ppo-write-off-analysis) walks through the eight-step math, and the [PPO drop calculator](/tools/ppo-drop-calculator) will tell you the break-even patient loss for the plan you're considering. What follows is the execution plan for after you've decided: the sequence I actually use, the letter, and the scripts.

## Do the math before you set a date

I'm not going to re-litigate the decision here, because [how to drop dental PPOs](/how-to-drop-dental-ppos) and the write-off analysis already cover it in detail. But the short version, because it changes how confident you'll be during the next 90 days: your break-even patient loss equals the write-off percentage on that plan. If the plan discounts your fee by 30%, you can lose 30% of its patients and land in the same place financially, before accounting for the freed-up chair time or the time you stop spending on claims and appeals.

Know that number before you start the clock. Everything below gets easier when you're not privately unsure whether this was the right call.

One more precondition worth naming: going fully out of network only works if your practice is willing to become a marketing-driven business, not just a clinically excellent one. Budget roughly 10% of revenue on marketing, and expect to be genuinely marketable: reviews, an online presence, the whole picture, because you're replacing the patient flow a directory listing used to hand you. I get into why in [the dental insurance trap](/dental-insurance-problems-solution).

Here's the whole sequence at a glance, then we'll walk through each stage.

*The sequence matters more than the calendar. Some practices run it in 60 days, some stretch it to 120, but the order stays the same: train, then write, then talk, then go.*

## T-90: train the whole team before a single patient hears anything

The single biggest predictor of a rough transition is a team that isn't ready when the first patient asks a question. Not a team that disagrees with the decision. It's a team that hasn't practiced saying the same thing the same way.

Ninety days out, before any letter goes in the mail, sit down with everyone: doctors, hygienists, front desk, everyone who touches a patient. Walk through why the change is happening, what is and isn't changing for patients, and what to say when someone asks about it. Then role-play it. Out loud, more than once, until it stops sounding rehearsed.

This is the step people skip, and it's the one that turns a smooth transition into a shaky one. A team that has role-played the objection for a month doesn't sound rattled when a patient actually raises it. A team that heard about the change for the first time in the same conversation as the patient will sound exactly as unsure as they are, and patients pick up on that faster than any script accounts for.

## T-60: send the letter

At 60 days out, patients get a personal letter, not a form notice buried in a billing statement. Keep the tone positive and specific: what's staying the same (the doctor, the team, the standard of care), what's changing (the plan relationship), and why you're doing it.

> **Letter template: going out of network**
> Dear [Patient Name],
>
> We want to let you know about a change taking effect on [date]. Starting then, our practice will no longer be in-network with [Plan Name].
>
> This is a change we're making so we can keep providing the level of care you deserve, without the restrictions that come with that plan's fee schedule. Nothing else about your care is changing: the same doctors, the same team, and the same standard we've always held ourselves to.
>
> You'll still be able to use your insurance benefits. We will continue to file your claims as a courtesy, and your plan will reimburse you directly for out-of-network care, generally at a lower percentage than in-network. We're also happy to talk through what your plan pays out of network, and to tell you about an in-house membership option if a predictable, insurance-free price is what you're looking for.
>
> If you have any questions at all, please call us at [phone] or ask any of us at your next visit. We're genuinely glad to have you as a patient, and we want this transition to be as smooth as possible for you.
>
> Warmly,
> [Doctor name] and the [Practice name] team

Adapt every bracket. The specific language about what changes and what doesn't should match your practice, not mine, but keep the structure: reassurance first, the practical facts second, an invitation to ask questions last.

## T-30: the conversations, and the front-desk script

The letter starts the conversation; it doesn't finish it. Thirty days out, every patient who has an appointment on the books should hear about the change chairside, in person, from someone on the team, not just find out from the mail.

This is also when the front desk starts fielding the question directly, usually as: "Are you in network with my plan?"

> **Script: "are you in network?"**
> "We're out of network with that plan, but we still submit the claims so you're reimbursed directly. Being out of network also lets us use the best materials and labs without insurance restrictions."

That's the shape of it, not the exact words to memorize. Practice it until your team can say it in their own voice and follow up naturally when a patient asks the obvious next question: what does that actually mean for what I pay?

Be straight about it. Filing claims as a courtesy means you still complete and submit the claim form so the patient doesn't have to. What changes is who gets the check: an in-network plan pays the practice directly, while an out-of-network plan typically reimburses the patient, usually at a lower percentage of the fee than the in-network rate. The exact numbers depend on the patient's specific plan, so don't promise a figure you don't know. Tell them to call their insurer and ask what their out-of-network benefit actually pays, and offer to help them read the answer once they have it.

For patients who want a predictable number instead of an insurance guessing game, this is also the moment to introduce an in-house membership plan as an option. I cover how to build and price one in [how to build a membership plan](/dental-membership-plan-design); the short version is that it replaces "what will my insurance pay?" with a flat annual fee you both already know.

## Day one, and the weeks that follow

On the day the change takes effect, two things should already be done: recare should be pre-scheduled for as many existing patients as you can manage, and your team should be tired of practicing the script, not hearing it for the first time.

Pre-scheduling recare matters more than it sounds like it should. A patient who is already booked for their next cleaning under the new terms has, in effect, already said yes to staying. A patient whose next visit is "whenever it's convenient" is a patient who has time to shop around, or simply forget to rebook.

After day one, track the transition weekly, not quarterly. A dip you catch in week two is a conversation with the team that week. A dip you don't notice until the quarterly numbers come in is a much bigger problem by the time you see it.

| Metric | Watch for | If it dips |
|---|---|---|
| New-patient calls | Week-over-week volume | Check the phone script and online reviews, not just the transition |
| Cancellations | Rate versus your normal baseline | Have the front desk ask why, and note the reason |
| Case acceptance | Percentage of treatment plans accepted | Revisit how the team is presenting cost, especially near-term |

If you already run [weekly profitability reports](/weekly-dentist-profitability-reports), fold these three lines into that same habit instead of building a separate tracking system. The point isn't a new spreadsheet. It's catching a problem while it's still small enough to fix in a huddle.

Normal patient churn in a healthy practice runs 15–18% a year for reasons that have nothing to do with insurance: people move, change jobs, or simply age out of a location. Don't chase every departure back to the plan you dropped. Some of it was always going to happen.

## Do this Monday

- Confirm the break-even math on the plan you're leaving, using the [PPO drop calculator](/tools/ppo-drop-calculator), so you know your number before you announce anything.
- If you haven't chosen which plan to drop first, read [which PPO to drop first](/which-ppo-to-drop-first): start with your lowest-volume plan as the rehearsal.
- Set the date, then count backward: T-90 for team training, T-60 for the letter, T-30 for conversations.
- Draft your version of the letter and the "are you in network?" script this week, and put the first role-play session on the calendar before you leave the building today.
- Start pre-scheduling recare for patients on that plan now, on the current terms, so the column isn't empty on day one.
- Decide whether you'll offer an in-house membership plan alongside the transition, and if so, get the pricing and materials ready before T-30, not after.

None of this is complicated. It's just a sequence, done in order, with a team that has practiced it out loud before a patient ever asks the question for real.