Imagine this: you’re seeing a loyal patient of 10 years. The treatment goes great, the patient smiles, hugs your front desk team (maybe even drops off a box of donuts), and then… bam! Weeks later, you get the dreaded EOB: “Provider is not in-network.” Excuse me?

Welcome to the modern horror story of insurance ghosting.

That’s right, many dentists across the country are finding themselves mysteriously removed from insurance networks—without notice. No calls. No letters. No "It’s not you, it’s us." Just dropped. And when the patient finds out? Guess who they blame? Not the billion-dollar insurance company. Nope. They blame you, the local doc trying to make an honest living while surviving on reimbursement rates that haven’t kept up with gas prices from 2006.

So, What’s Actually Happening?

Insurance plans are "accidentally" terminating provider contracts at an alarming rate. It’s often blamed on:

• A "clerical error" (aka: someone spilled their Starbucks on the server),

• "Incomplete credentialing documents" that were sent… three times,

• Or no explanation at all.

To make it worse, they’re not notifying the doctor, and definitely not notifying the patient—which leads to total chaos when the claim is processed at out-of-network rates.

Ironically, many of these plans are desperate for providers because their networks are shrinking like a cotton scrub jacket in the dryer. Yet instead of fixing their systems, they double down on denial scripts and leave you to clean up the mess.

Can They Legally Do That?

This is where things get murky. Insurance companies operate under contract law, not patient care law. You have the duty to not abandon patients. They just have a duty to… collect premiums, it seems?

However, depending on your state, there may be laws or regulations that offer a little hope:

1. Retroactive In-Network Protections (in some states)

States like Washington, Texas, and Georgia have laws that force insurance plans to pay in-network rates during the credentialing process, even if it’s incomplete. This may also help if you were removed and are reapplying.

But beware: not all states have this protection, and it doesn’t always apply to wrongful terminations. It’s usually reserved for doctors who are in the middle of initial credentialing.

2. Patient Abandonment Laws – But Not for Insurance

Patient abandonment refers to a doctor abruptly ending care without providing the patient reasonable notice or a replacement provider. Ironically, you, the doctor, can get in trouble for this—but insurance plans? Not so much.

There’s currently no national law requiring insurance companies to notify patients or providers of a termination in a timely manner. So technically, the plan might drop you and walk away Scott-free… unless you fight back.

Your Rights and Options as the Wrongfully Dropped Dentist

1. Appeal the Termination

Insurance companies usually have internal appeal or recredentialing processes. The problem is, the burden is on you to discover the issue and clean it up. So get your practice management system to flag sudden reimbursement changes.

2. File a Complaint with the State Department of Insurance

Each state has an insurance commissioner or department that oversees fair provider practices. Filing a formal complaint is one of the few ways to push accountability. Bonus: these records go public, and you may not be the only one complaining.

3. Contact Your Patients Proactively

If you discover the issue before your patients do, get ahead of the narrative. Send letters, make calls, and let them know it was the plan’s mistake—not yours.

Example Script:

“We’ve been informed that our in-network agreement with XYZ Insurance was terminated without our knowledge or consent. We are currently working to resolve this with the insurance company, and will honor in-network fees during this process. Please know we are still here for you and committed to your care.”

4. Honor In-Network Rates (Temporarily)

Yes, it may cost you in the short term, but if the insurance plan wrongfully dropped you and you’re working on reinstatement, honoring your previous fee schedule can protect the patient relationship and reduce tension. Keep in mind that there are overbilling laws to consider so if you do this, make sure you follow your state laws as well as federal laws on how to do this without getting into trouble.

5. Get Legal Help (if it’s a pattern)

If you notice that multiple claims are being downgraded due to wrongful terminations, and your reinstatement efforts are being ignored, it may be time to involve a healthcare attorney. Repeated wrongful terminations could be viewed as bad faith practices—especially if there’s financial harm to your patients.

Why Would Insurance Plans Do This?

Simple: because they can.

But here’s a possible motive: some plans are quietly cleaning up their networks, dropping higher-fee providers without formally admitting it. Others are just disorganized. And some use third-party administrators (TPAs) who screw things up faster than you can say “single molar crown D2740.”

And guess who’s caught in the middle?

• The patient, confused about their bill.

• The front desk, dodging blame.

• The doctor, who now has to rebuild trust that shouldn’t have been lost in the first place.

Proactive Steps to Protect Yourself

• Audit your contracts annually. Know when they renew and if the plan has any automatic recredentialing requirements.

• Ask for written notice of any changes. Don’t rely on EOBs to tell you what your contract says.

• Work with credentialing professionals. (Veritas Dental Resources, anyone?) We help you stay one step ahead.

• Document EVERYTHING. Every fax, every portal message, every conversation with a provider rep—keep it in writing.

Final Thought: You’re Not Crazy—The System Is

If you’ve been ghosted by an insurance company, you’re not alone. Thousands of dentists have faced the same gut punch. But your best weapon is vigilance, communication, and a refusal to stay silent.

You have the right to be notified. Your patients have the right to transparency.

And when insurance companies forget that? It’s up to dentists—armed with knowledge, a loyal patient base, and maybe a great legal team—to remind them.

If your office was recently dropped and you didn’t even get a breakup text, drop a comment, send a smoke signal, or give us a call at Veritas Dental Resources. We’ll help you figure out whether it was an accident… or just plain insurance negligence in disguise.

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