Patient Payments After Going Out-of-Network: Everything You Need to Know

One of the biggest anxieties dentists face when considering the transition out of insurance networks is the payment question: How will patients pay when insurance companies no longer send checks directly to the practice? This comprehensive guide addresses assignment of benefits, patient payment resistance, and proven strategies for maintaining cash flow and patient relationships during this critical transition.

Understanding Assignment of Benefits After Going Out-of-Network

When you resign from a PPO plan, one critical question becomes: Can you still accept assignment of benefits (AOB)? This determines whether insurance reimbursement comes to you or directly to the patient.

What Assignment of Benefits Means

Assignment of benefits is an authorization allowing the insurance company to send reimbursement checks directly to your practice rather than to the patient. This has significant cash flow implications.

The Insurance Company Variation

Most insurance companies allow out-of-network practices to accept assignment of benefits. However, Delta Dental and some regional carriers have restrictive policies that may not allow this. Before dropping a plan, check their specific policies regarding out-of-network AOB.

Strategies for Assignment of Benefits

• Check with each carrier: Contact them directly before resigning to understand their out-of-network AOB policies
• Maintain involvement with insurance: Some consultants recommend completely stepping back from insurance—don't. Continue to file claims and help patients maximize their benefits
• Patient-friendly approach: If insurance sends checks to the patient, provide clear communication and payment schedules

The Reality of Payment Collection When Going Out-of-Network

When you resign from insurance, patients face a significant psychological shift: they suddenly see a bill they previously perceived as "free" or partially covered by insurance.

The Biggest Shock: Preventive Visit Fees

Surprisingly, it's not the cost of a crown or implant that surprises patients most—it's the adult hygiene visit. Many patients believe cleanings are "free" because insurance covered them at 100%. Once you're out-of-network, that changes dramatically.

Out-of-network hygiene visit costs vary significantly based on the patient's plan:

• Some patients: $0 (no out-of-network coverage)
• Typical range: $50-$150
• High deductible plans: Up to $240+

This psychological shift is your biggest patient retention challenge. Prepare for questions and resistance around preventive care costs.

Strategies for Collecting Payment at Time of Service

The most effective approach is collecting payment at the time of service rather than billing patients later. This improves cash flow and avoids collection problems.

Overcoming Patient Resistance to Upfront Payment

Patients accustomed to insurance-covered care may resist paying at the appointment. Here's how to address this:

The Reframing Approach

Instead of: "That will be $150 out-of-pocket for your cleaning."

Say: "Your insurance will process the claim and may reimburse you directly. In the meantime, we need to collect the full fee today. Many of our patients receive their insurance reimbursement within 2-3 weeks. If you don't receive your check within 14 days, contact your benefits supervisor to follow up."

Key Elements of This Approach

• Acknowledges the insurance reality
• Sets clear expectations about timing
• Gives patients a path to get reimbursed
• Doesn't apologize for the fee
• Maintains professional confidence

Creating Effective Payment Options

Money may not be the issue—but a lack of payment options can be. Offering multiple payment methods reduces resistance significantly.

The Hygiene Visit Fee Challenge: Detailed Strategy

Since hygiene visits cause the most patient resistance, create a specific strategy for this:

Before the Transition

• Schedule prophylaxis appointments well in advance (60-90 days before you drop insurance)
• Contact patients individually to discuss the coming change
• Explain what hygiene visit costs will look like out-of-network
• Collect insurance details and estimate out-of-network co-pays using EOBs

At the Appointment

• Briefly reinforce the value of preventive care
• Present the fee matter-of-factly (not apologetically)
• Offer payment options before care
• Collect payment before the appointment begins

After the Appointment

• File the insurance claim and provide EOB information to patients
• Follow up if the patient reports they haven't received their reimbursement within the expected timeframe
• Use this as an opportunity to educate about insurance limitations

Managing Money as the Discussion Topic

Is money really the issue when patients resist going out-of-network? Research suggests otherwise.

The Money Perception vs. Reality

Patients who can afford a $1,000 crown don't typically balk at a $50 hygiene co-pay because of actual financial inability. They balk because it violates their expectations ("I thought this was free"). Money becomes the stated objection, but expectation violation is the real issue.

How to Address This

• Validate the financial concern (don't dismiss it)
• Reframe the value proposition
• Offer options and flexibility
• Focus on the benefits of out-of-network care (more time, better options, personalized treatment)

Specific Patient Responses and Scripts

Patient: "I didn't think I'd have to pay for my cleaning."

Response: "I understand. Because we were in-network, your insurance covered the preventive portion. Now that we've transitioned out-of-network, you'll pay our fee, and your insurance may reimburse you directly. Many of our patients actually prefer this because they have more control over where they get their care. We're still here to help you maximize your benefits."

Patient: "I can't afford the out-of-network fee."

Response: "I hear your concern. Let me show you our payment options. We can set up a payment plan, you can use a credit card, or we can work with you on timing. The goal is to keep you healthy and find a way that works for your budget."

Patient: "Why did you drop my insurance?"

Response: "We made this change to focus on what's best for your care. When we were in-network, insurance companies limited what we could recommend and they control our fees. By going out-of-network, we can offer you optimal treatment without those limitations. You'll actually have more control over your care decisions."

Financial Implications and Cash Flow Management

Going out-of-network affects cash flow differently than staying in-network:

In-Network Model

• Patient pays co-pay at appointment
• Insurance reimburses practice 30-45 days later
• Cash flow is delayed but predictable

Out-of-Network Model (Insurance Reimburses Practice)

• Patient pays full fee at appointment
• Insurance reimburses practice directly
• Better immediate cash flow, potential for insurance reimbursement

Out-of-Network Model (Insurance Reimburses Patient)

• Patient pays full fee at appointment
• Patient receives reimbursement from insurance
• Excellent immediate cash flow, but requires patient education

Team Training for Payment Discussions

Your entire team must be confident and consistent in payment conversations:

• Front desk: Should present fees confidently and offer payment options
• Clinical team: Should be prepared to discuss treatment value and payment if questions arise
• Billing staff: Should know how to explain insurance reimbursement timing and options

Practice these conversations weekly. Role-play different patient objections and responses. The more natural your team's responses feel, the less resistance you'll encounter.

Preventing Patient Loss Through Strategic Communication

You can minimize patient loss by:

• Giving advance notice: 60-90 days minimum
• Having conversations: Face-to-face or phone when possible
• Explaining benefits: Focus on improved care, more time, better options
• Addressing fees directly: Don't hide fees or apologize—present them confidently
• Offering flexibility: Multiple payment options reduce resistance
• Maintaining support: Continue to help patients maximize their insurance benefits

Reality Check: Most dentists expect to lose 25-40% of their patient base when going out-of-network. However, with excellent communication and strategy, you can retain 70-80% of your existing patients.

Your Path Forward

Payment collection after going out-of-network is manageable with proper planning and communication. The key is understanding that patient resistance isn't primarily about ability to pay—it's about expectations and clarity. When you communicate clearly, offer options, and maintain support for patients' insurance benefits, most patients will stay and pay.

Ready to Master Your Transition?

Get expert guidance on creating payment systems and patient communication strategies for your out-of-network transition.

Schedule a Coaching Strategy Meeting with Gary

Related Resources

• Complete insurance decision framework
• Master insurance conversation scripts
• Strategic fee setting and pricing

This guide consolidates payment management strategies from the Less Insurance Dependence Podcast, drawing from real-world case studies and proven practices implemented by dental professionals working with coaches Gary Takacs and Naren Arulrajah.

Reviewed by

Naren Arulrajah

CEO & Founder, Ekwa Marketing

Naren Arulrajah is the CEO and Founder of Ekwa Marketing, a 300-person dental marketing agency that has helped hundreds of practices grow through SEO, reputation management, and digital strategy. A published author of three books on dental marketing, contributor to Dentistry IQ, co-host of the Thriving Dentist Show and the Less Insurance Dependence Podcast, and a member of the Academy of Dental Management Consultants. He has spent 19 years focused exclusively on helping dental practices succeed online.