Dentists, you can break free of insurance.

How dentists can break free of insurance to join the out-of-network world

Oct. 3, 2023
If you’re wondering how to escape the insurance model and gain control of your practice, here are some helpful ideas from a dentist who's been there.

Despite the growing dissatisfaction with the insurance model among many dentists, a lot of dentists I talk to—in my community as well as online—cannot fathom that any patient would go to an out-of-network dentist, let alone pay full fee at the time of service. 

Many dentists still conduct business following the medical model, where treatment is recommended and no fee is quoted, treatment is completed, a claim is filed, and the patient is billed for their portion. The practice then waits for the patient to pay whatever they choose to pay each billing cycle until the balance is paid off.

This model works for some, but many dentists are hurting financially and suffering from burnout as insurance reimbursements are reduced and other costs rise. If you’re wondering how to escape the insurance model and gain control of your practice, here are some helpful ideas. 

You might also want to read:

Escaping the hold insurance companies have on your practice

Escape insurance and profit 

While in dental school, we took courses in oral diagnosis and treatment planning and comprehensive patient care that taught us blueprints for the way many of us would like to practice. Even then there were those who just wanted to get the patient in the chair to do the crown or endo to satisfy graduation requirements. I was fortunate to have a few patients in dental school who needed a lot of work. I remember one woman, Marie, for whom I did multiple crowns, bridges, extractions, and endos. This taught me a valuable lesson—comprehensive care is a great way to develop relationships with patients and get a lot of work done. 

Back then, the work was inexpensive for patients, and I didn't have to worry about insurance. But now, in private practice, our fees and insurance coverage are a constant concern for every patient. What hasn't changed is the need to look at the entirety of a patient's needs and the benefits of comprehensive care for the patient and practice.

After all, if money and insurance were no object to treatment acceptance, would you rather do one crown in an hour or two adjacent crowns in that same hour? To take this example further, would you rather do four crowns on four patients in four hours or an upper arch of 14 crowns on one patient for four hours? Since most patients don't particularly like sitting in a dental chair, I think they’d like to expedite their treatment. 

The problem is that fees and insurance are an obstacle to comprehensive treatment. Contrary to the views of many dentists, the financial barriers can be overcome. But it takes some work, not just third-party financing. 

If you want to join the out-of-network, fee-for-service world, you cannot continue to conduct your practice in the same way you always have. The status quo will not work. You must set yourself apart from the average insurance-based practice, and the way to do that is with your service. It's way easier to compete on service than on price because service in the medical/dental world is generally not outstanding. 

The value of customer service 

Years ago, I went to a course by Ken James, DDS, who discussed the concept of customer service in dental practice. I was blown away! He talked about realistic scheduling so you can run on time, thorough comprehensive exams, outstanding treatment plan presentations, and great customer service.

Just listening to his ideas on customer service inspired me and my staff to come up with all kinds of creative ideas. We made sure that all our magazines were fresh, our bathroom was cleaned after each use and stocked with amenities, and our goody bags were upgraded. Times have changed, and there are mountains of books on customer service, but the importance of outstanding customer service is as valuable as ever. 

Beyond customer service, it’s helpful to have a nice office, not necessarily over the top, but clean, uncluttered, up to date, nicely decorated, and professional. You must also have a staff who is 100% customer service-oriented and 100% on board with your concept of a practice model. Even one person who is not on board can blow things for you. So, coach or fire, but don't ever retain a poor performer who’s working against you. 

You must also have great marketing, because if you're not on an insurance list, how are patients going to find you? Remember that your marketing medium is just as important as your message, and you must have a compelling message. You must also bear in mind that the best marketing medium is a moving target that changes with time. Years ago, all you had to do was hang out a shingle and place an ad in the Yellow Pages, and that’s moved to targeted social media ads and SEO. Who knows what's next? 

You must also have great communication skills in all aspects of your interactions with patients and staff. I believe in clear, upfront, honest, complete communication, whether in your marketing message, your initial contact, your consultation, your exam, your treatment presentation, your informed consent discussion, your financial discussion, your post op discussion, or your post op phone call/text message. 

When all is said and done, you must deliver the goods, and you must be painless. Great customer service will take you a long way, but having outstanding clinical skills will take you further. Find a few clinical services that you really like to do and become very good at them. Along with great service, this will be the niche to set yourself apart. For me, it's porcelain veneers, IV sedation, and Invisalign.

You must set yourself apart and be the best dentist you can be. This includes your practice philosophy, customer service, staff, marketing, communications, and clinical skills. If you make your practice so attractive that patients don't want to go anywhere else, I believe you’ll fill your practice with enough patients to provide you with a very rewarding career, and you’ll provide your patients with a very positive experience.

Editor's note: This article appeared in the October 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

About the Author

Josh Bernstein, DDS

Josh Bernstein, DDS, is a clinical instructor in cosmetic dentistry, full-mouth reconstruction, and IV sedation, as well as a conscious sedation evaluator for the Dental Board of California. He lectures nationwide and is published nationally and internationally. He and his wife, Allison Bernstein, have a private, fee-for-service, out-of-network practice in Oakland, California, focusing on cosmetic dentistry, sedation dentistry, and Invisalign. Visit for more info.

About the Author

Allison Bernstein

Allison Bernstein, is a practice management professional with expertise in teaching patient communications to assist dentists and their teams on becoming less dependent on insurance. She and her husband, Josh Bernstein, DDS, host a podcast called Dental Suite 903 and have a Master Class by the same name. They have a private, fee-for-service, out-of-network practice in Oakland, California, focusing on cosmetic dentistry, sedation dentistry, and Invisalign. Visit for more info.

Sponsored Recommendations

Clinical Study: OraCare Reduced Probing Depths 4450% Better than Brushing Alone

Good oral hygiene is essential to preserving gum health. In this study the improvements seen were statistically superior at reducing pocket depth than brushing alone (control ...

Clincial Study: OraCare Proven to Improve Gingival Health by 604% in just a 6 Week Period

A new clinical study reveals how OraCare showed improvement in the whole mouth as bleeding, plaque reduction, interproximal sites, and probing depths were all evaluated. All areas...

Chlorine Dioxide Efficacy Against Pathogens and How it Compares to Chlorhexidine

Explore our library of studies to learn about the historical application of chlorine dioxide, efficacy against pathogens, how it compares to chlorhexidine and more.

Enhancing Your Practice Growth with Chairside Milling

When practice growth and predictability matter...Get more output with less input discover chairside milling.