In today’s evolving dental landscape, dentists are rethinking how they operate their practices. One of the biggest decisions facing any dental office is whether to participate with dental insurance plans or to go entirely fee-for-service (FFS).

While these two models may seem like opposing paths, both can lead to financial success—if implemented strategically. Understanding the key differences between them helps dentists make informed, intentional decisions about how they want to practice.

Model 1: Insurance-Based Practices

Participating providers, or in-network dental offices, sign contractual agreements with insurance companies (primarily PPOs) to accept reduced reimbursement rates in exchange for patient volume.

Pros:

• Higher patient volume: Insurance networks funnel patients into in-network offices.

• Lower marketing costs: Patients are often referred by their insurance directories.

• Easier new patient acquisition: Many patients prioritize using their benefits.

Cons:

• Lower profitability: PPO write-offs average 30–50% of UCR fees (ADA, 2023; Dr. Charles Blair, Practice Booster).

• Increased admin burden: Claim filing, denials, and insurance phone calls take staff time.

• Less clinical freedom: Reimbursement rules may influence treatment planning.

Example:

A 2023 ADA report found that insurance-based practices have higher gross production but lower net income per procedure, due to contractual fee adjustments and administrative costs.

Model 2: Fee-for-Service (FFS) Practices

In a fee-for-service model, the dentist is not contracted with any insurance company. Patients pay the practice directly, and may be reimbursed by their insurance company (if applicable) out-of-network.

Pros:

• Higher reimbursement per procedure: Dentists set their own fees based on value and expertise.

• Greater autonomy: No preauthorizations or coding constraints.

• Stronger patient relationships: Focus shifts from insurance limitations to comprehensive care.

• Lower admin costs: Less time spent on claims, appeals, and insurance logistics.

Cons:

• More patient education required: Teams must help patients understand out-of-network benefits.

• Greater marketing need: FFS practices typically rely more on referrals, community reputation, and online visibility.

• Potential patient drop-off during transition: Some insurance-dependent patients may leave if the office exits PPOs without a transition plan.

Evidence:

According to the Levin Group and Dental Success Institute, successful FFS practices often achieve higher net income with fewer patients, offering a less stressful and more personalized model of care.

Additionally, Dental Economics (2022) reports that many FFS practices achieve operating profit margins of 40% or more, compared to the national average of 25–30% for PPO-based offices.

Quick Comparison: In-Network vs. Fee-for-Service

PPO Practice:

• Patient Volume: High

• Reimbursement: Reduced (30–50% write-offs)

• Admin Burden: High

• Profitability per Procedure: Low to Moderate

• Clinical Autonomy: Limited by contracts

• Marketing Dependency: Low (insurance lists)

Fee-for-Service Practice:

• Patient Volume: Moderate to High (with loyalty)

• Reimbursement: Full UCR fee

• Admin Burden: Low

• Profitability per Procedure: High

• Clinical Autonomy: Full autonomy

• Marketing Dependency: Higher (referrals & brand)

Transitioning from PPO to Fee-for-Service

While both models can be profitable, many dentists are seeking more autonomy and better margins by reducing insurance dependence. Transitioning takes planning, but it’s increasingly common.

Statistics to Support:

• Practices that reduce PPO participation often see increased profitability within 12 months (Dental Success Institute, 2023).

• 60–80% of patients stay with their dentist after the practice goes out of network, when proper communication is in place (Dental Intelligence).

Tools and Experts to Help You Succeed

Thinking About Going Out of Network?

We recommend Gary Takacs from ThrivingDentist.com. Gary is one of the most respected voices in the dental industry and has coached thousands of dentists on building successful, thriving fee-for-service practices with the right mindset, systems, and leadership.

Staying In-Network but Want to Improve Profitability?

If you're not ready to drop insurance yet, you don’t have to stay stuck with low reimbursements. Veritas Dental Resources (www.veritasdentalresources.com) is a trusted industry leader that helps in-network dentists:

• Negotiate higher PPO fees

• Analyze plan profitability

• Create custom strategies to improve margins while staying insurance-friendly

Many clients see significant revenue growth without changing their practice model—just by making smarter decisions with their existing insurance contracts.

Conclusion: Choose the Model That Aligns With Your Vision

There is no “one-size-fits-all” when it comes to dental practice models. Both in-network and fee-for-service practices can be highly profitable and fulfilling—if aligned with the dentist’s goals, systems, and patient experience strategy.

The key is to understand:

• What kind of dentist you want to be

• How you want to serve your patients

• And what kind of lifestyle and autonomy you want your practice to support

No matter your path, you don’t have to do it alone. With the right advisors, data, and systems, you can create a practice that’s not just productive—but truly thriving.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com