Why More Dentists Are Going Out of Network—And What Patients Need to Know
If you’ve been wondering why your dentist just went out of network with your insurance plan, you’re not alone—and neither is your dentist.
Across the country, more and more dental professionals are making the difficult (but increasingly necessary) decision to cut ties with dental insurance companies. While dentistry is a noble healthcare profession grounded in care, ethics, and clinical excellence, the cold hard truth is that insurance reimbursement is failing to keep up with the real cost of delivering quality dental care.
And guess who’s footing the bill? Often—it’s the dentist. Let’s unpack this crisis, what it means for you and your patients, and how dentists can use this moment to finally shift the blame back where it belongs: the insurance companies.
The Tooth-Hurty Truth: PPO Fees Are Financially Unsustainable
Let’s start with hygiene wages.
In many U.S. markets, hygienists now earn between $45–$60 per hour— up 20-60% before the Covid-19 pandemic. Hygiene is a specialized skill, critical to patient health and to catching early signs of disease.
But now consider this: most PPO insurance plans pay about $50–$70 for an adult cleaning (D1110). You do the math.
By the time you factor in the hygienist's wage, benefits, sterilization protocols, operatory maintenance, instruments, front office payroll, and oh yeah—the cost of breathing—your dental office just lost money. All to help your patient stay healthy.
Ask insurance to voluntarily take a loss like that, and they’ll call their attorneys before your next patient is seated.
Dentists Are Not Charities—But PPOs Sure Want Them to Be
Dental insurance companies love to sell patients on the illusion of “comprehensive benefits.” But in reality, less than 6% of Americans with dental insurance ever use their full annual maximum, which usually sits around a dismal $1,000–$1,500. That’s the same max we saw in the 1970s, except now your crown lab bill alone can cost more than that.
When insurance denies a necessary crown, perio scaling, or even a buildup that any reputable clinician would call mandatory, the patient is the one who gets angry—but not at the insurance company.
They call your office, yell at your team, leave a bad Google review, and threaten to “find someone in-network.”
Let’s Get One Thing Straight: Insurance Companies Make Mistakes—A Lot
When claims get denied due to "missing information" or "lack of necessity," it’s usually not because your staff did anything wrong. It’s because the insurance plan is delaying payment, avoiding payment, or following a policy they buried in a 72-page manual they never gave you access to.
And guess who takes the heat for it? The dentist.
Insurance plans make mistakes all the time. But instead of fixing those mistakes quickly, they:
Make your staff sit on hold for 3 hours.
Lose attachments.
Deny on technicalities.
Then blame your office for “improper documentation.”
Meanwhile, the patient assumes you’re the problem.
A Wake-Up Call for Patients: Complain to the Right People
Here’s a simple truth your patients need to hear:
“Your dentist didn’t deny your claim—your insurance did.”
If patients are mad, help them channel that energy toward the people actually responsible. Here’s a script you can post in your office, email to patients, or even print on a small handout card:
Patient Communication Script:
“We completely understand your frustration. Unfortunately, your insurance plan has chosen not to cover this treatment—even though it’s clinically necessary. We recommend that you contact your insurance company directly to express your concern. You also have the right to file a formal complaint with your state insurance commissioner. We’re happy to help you with any documentation you may need to do that.”
Where Patients Can Send Their Complaints
To their Insurance Plan:
Call the number on the back of their insurance card.
Ask to file a formal grievance or appeal.
Document everything.
To their Employer’s HR Department:
Most dental plans are chosen by employers. If enough employees complain, the employer may switch plans or demand accountability.
To the State Insurance Commissioner:
This is the best avenue for official complaints. Every state has an insurance commissioner who regulates unfair practices.
Patients can find their state commissioner’s contact info here:
Why Dentists Are Leaving PPOs: Because It's Time
Dentists didn’t get into this profession to nickel-and-dime patients. They entered this field to heal, educate, and help people live healthier lives.
But when insurance companies:
Refuse to pay enough to cover basic operating costs,
Interfere with diagnoses and clinical decisions,
Punish offices for trying to do the right thing,
…then dentists are left with two options:
Stay in-network and lose money, risking staff burnout, poor care, and eventually closure.
Go out-of-network, take control, and offer the kind of care patients truly deserve.
And more dentists are choosing the second option. Not because they don’t care about patients. But because they do.
Final Word for Dentists: Keep Your Head Up, and Educate Relentlessly
If you're a dentist tired of being the scapegoat for insurance denials, you're not alone. Going out of network may feel scary—but staying in-network when it no longer makes sense is scarier.
Here’s how you turn the tide:
Be transparent with your patients.
Give them the language to advocate for themselves.
Provide tools and resources like commissioner links and appeal forms.
And most importantly—don’t let insurance bullies redefine your value.
Your clinical expertise, your compassion, your team, and your mission are worth far more than a $48 cleaning reimbursement.
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
