When Should an Orthodontic Practice Go Out of Network?

By Jill Allen | Hey Docs! Podcast with Megan and B Wyrick, Co-Founders of The Wyrick Outlook

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For many orthodontic practices, participating in insurance networks is simply part of doing business. Being in-network can help attract patients, create opportunities for growth, and make treatment feel more accessible to families. But as a practice becomes more established, the financial impact of those insurance agreements deserves a closer look.

Are the contracts still benefiting the practice? How much revenue is being written off? And at what point does remaining in-network cost more than the value it provides?

On this episode of the Hey Docs! Podcast, Jill Allen welcomes back Megan and B, sisters and co-founders of The Wyrick Outlook, to discuss what orthodontic practice owners should consider before transitioning from an in-network insurance model to fee-for-service.

While the idea of gaining more control over fees can be appealing, the decision requires more than simply terminating insurance contracts. Practices need to understand their financial position, evaluate their patient base, prepare their teams, and develop a strategy that protects both the patient experience and the business.

When Does Being In-Network Stop Benefiting Your Orthodontic Practice?

Insurance participation can serve an important purpose, particularly for startups and practices working to establish a consistent flow of new patients. Being listed as an in-network provider may help introduce the practice to families who otherwise would not have considered it.

However, the value of those relationships can change as a practice grows.

Megan and B encourage doctors to look closely at what each insurance contract is actually contributing to the business. An agreement that once helped establish patient volume may no longer provide the same financial benefit, especially if reimbursement rates have not kept pace with the practice's expenses.

The first step is understanding how much the practice is writing off under each agreement and whether the patient volume associated with that contract justifies the difference between the practice's fees and the contracted reimbursement.

It is also important to understand why patients are choosing the practice. Are they coming primarily because the office is in-network, or are they choosing the doctor based on reputation, referrals, convenience, and the overall patient experience?

Those answers can help determine whether remaining in-network is still supporting the practice's goals.

JA&A Insight: Insurance participation should be evaluated like any other business decision. A contract that brings patients into the practice is valuable only when the financial impact makes sense for the business.

Can Orthodontic Practices Accept Insurance While Out of Network?

One misconception surrounding fee-for-service orthodontics is that going out of network means patients can no longer use their insurance benefits.

Megan and B explain that this is not necessarily the case. Depending on the patient's plan, out-of-network benefits may still be available, and the practice may be able to help patients understand and use those benefits.

The distinction is that the practice is no longer operating under the same contracted fee arrangement with that insurance company.

This can give the practice more flexibility in establishing its own fees, but it also changes how benefits and patient financial responsibilities may need to be communicated.

For orthodontic practices, that makes insurance knowledge and financial presentation especially important. Team members need to understand how to explain the difference between in-network and out-of-network benefits without creating unnecessary confusion or making promises about coverage that may vary by plan.

Going out of network does not automatically mean losing every patient with that insurance carrier. It does mean the practice needs a clear process for helping families understand their options.

Know Your Numbers Before Leaving an Insurance Network

The decision to terminate an insurance contract should begin with a financial analysis, not frustration over reimbursement rates.

Before making a change, practice owners should understand the financial impact of each insurance relationship and how removing that contract could affect the business.

Important questions include:

• How much is the practice currently writing off under each insurance contract?
• How many patients and new starts are associated with each carrier?
• How much of the practice's revenue depends on those relationships?
• What would the financial impact be if some patients chose another provider?
• Does the practice have enough cash reserves to manage a temporary change in revenue?

These questions are particularly important because the financial impact of going out of network may not be immediately visible.

An orthodontic practice could experience changes in new patient flow, case acceptance, insurance payments, and collections as families adjust to the new model.

Understanding those possibilities before making the transition allows the owner to evaluate whether the practice is financially prepared.

Your New Patient Process Needs to Be Strong Before Making the Change

One of the most important points Megan and B emphasize is the need for a strong operational foundation before transitioning away from insurance networks.

If the practice is going to ask patients to choose its services without the same in-network advantages, the patient experience needs to support that decision.

That begins long before the doctor enters the exam room.

The initial phone call, scheduling experience, consultation, treatment presentation, and financial conversation all influence whether a family feels confident moving forward.

Practices should evaluate how consistently their teams communicate value and whether patients understand what makes the experience different.

This is not about becoming more aggressive with case acceptance. It is about making sure the team can clearly communicate the benefits of treatment, answer questions confidently, and help patients make informed decisions.

A practice that already has strong consultation and financial systems will be better positioned to manage the communication changes that come with transitioning out of network.

JA&A Insight: Before changing your insurance strategy, evaluate your new patient experience. If patients do not understand the value of your practice, removing an in-network advantage may make that gap more noticeable.

Why Orthodontic Practices Should Transition Out of Network Gradually

Leaving every insurance network at once may sound appealing, particularly when a practice is frustrated with contracted fees. However, Megan and B encourage a more measured approach.

Rather than making one sweeping change, practices can evaluate their contracts individually and determine which relationships make the most sense to reconsider first.

That might mean starting with a carrier that represents a smaller portion of the patient base or one whose financial terms are particularly unfavorable.

A gradual approach gives the practice an opportunity to monitor how the change affects new patient inquiries, starts, collections, and patient questions before making additional decisions.

It also allows the team to become more comfortable explaining out-of-network benefits and navigating financial conversations.

The goal is to create a manageable transition that can be evaluated along the way rather than introducing unnecessary financial and operational uncertainty.

Prepare Your Team for the Insurance Conversation

An insurance transition affects more than the doctor or the financial coordinator. It changes conversations happening throughout the practice, particularly at the front desk and during the new patient consultation.

Patients may call with questions about their benefits, whether the practice still accepts their insurance, or what the change means for their treatment costs.

If team members are unsure how to respond, those conversations can quickly create confusion.

Megan and B stress the importance of preparing employees before announcing changes to patients. Team members should understand why the practice is making the transition, which insurance relationships are affected, how benefits may work moving forward, and where to direct questions they cannot answer.

Consistent communication is especially important. Patients should not receive different explanations depending on which employee answers the phone.

Training should include practicing common questions and making sure employees feel confident explaining the change in a way that is accurate, helpful, and reassuring.

How Should You Communicate Insurance Changes to Patients?

Patients need time and clear information when a practice changes its insurance participation.

Megan and B recommend a proactive communication strategy that includes notifying affected patients and explaining what the transition means for them.

Written communication can help establish consistency, but the practice also needs to be prepared for individual questions. Insurance benefits vary, and families may need help understanding how their specific coverage could be affected.

The communication should explain the change without creating unnecessary alarm or suggesting that patients are losing access to orthodontic care.

It is also important to coordinate the timing and requirements of the transition with the applicable insurance contracts. Practices should understand their notification obligations and how existing patient agreements or treatment arrangements may be affected before announcing changes.

The more clearly the practice communicates, the easier it becomes for patients to make informed decisions about continuing or beginning treatment.

Protect Your Cash Flow During an Insurance Transition

Even when leaving an insurance network makes financial sense over the long term, there may be short-term changes to cash flow.

Payment arrangements can shift, patient financial responsibilities may change, and the practice may experience an adjustment period as patients and team members become familiar with the new model.

That is why Megan and B emphasize financial readiness as part of the transition strategy.

Practice owners should understand their current collections, financial obligations, and available reserves before making a significant change to insurance participation.

A startup or early established practice may have less flexibility to absorb fluctuations in patient volume or collections, while a more mature practice may have greater financial capacity to make adjustments.

However, practice age alone should not determine the decision. Each practice needs to evaluate its own financial position and determine whether the timing supports the change.

The Emotional Side of Going Out of Network

There is also an emotional component to this decision that can be easy to overlook.

For many doctors, insurance participation has been part of the practice's business model for years. The possibility of losing patients or experiencing a temporary decline in new starts can make leaving a network feel risky, even when the numbers suggest it is worth considering.

The team may have similar concerns, particularly if they are accustomed to presenting in-network benefits as part of the financial conversation.

Megan and B acknowledge that these transitions require patience and preparation. Practice owners need to understand why they are making the change and be comfortable working through an adjustment period without immediately questioning the entire strategy.

That does not mean ignoring the numbers or pushing forward regardless of the results. It means establishing realistic expectations, monitoring performance, and giving the transition an appropriate opportunity to work.

Frequently Asked Questions About Going Out of Network in Orthodontics

What does fee-for-service mean in an orthodontic practice?

A fee-for-service orthodontic practice establishes its own treatment fees rather than relying on contracted reimbursement rates from participating insurance networks. Patients may still have insurance benefits available, depending on their individual plans, but the practice is not necessarily bound by the same in-network fee agreements.

Can orthodontic patients use insurance benefits at an out-of-network practice?

Yes, some insurance plans provide out-of-network orthodontic benefits. However, coverage, reimbursement, payment arrangements, and patient financial responsibility depend on the specific insurance policy. Practices should verify benefits and explain potential costs before treatment begins.

When should an orthodontic practice consider going out of network?

An orthodontic practice should consider evaluating its network participation when contracted reimbursement rates, required write-offs, and administrative demands may outweigh the value of the patient volume associated with a carrier. The decision should be based on financial data, patient demographics, cash flow, and the practice's ability to communicate its value.

Should an orthodontic practice drop all insurance contracts at once?

A gradual transition may be easier to manage than terminating every insurance contract simultaneously. Practices can evaluate individual carriers, begin with contracts that offer less financial value, and monitor changes in new patient flow, case acceptance, and collections before making additional decisions.

How should orthodontic practices tell patients they are going out of network?

Practices should communicate insurance participation changes clearly and proactively, using written notices and consistent team messaging. Patients should understand when the change takes effect, whether out-of-network benefits may still apply, and how their financial responsibilities could change. Contractual notification requirements should also be reviewed.

What financial information should an orthodontic practice review before going out of network?

Practice owners should review insurance write-offs, patient and new start volume by carrier, production, collections, cash reserves, and the percentage of revenue associated with each insurance relationship. These metrics can help estimate the financial impact of leaving a network and determine whether the practice is prepared for a potential transition period.

Final Thought

Moving from an in-network insurance model to fee-for-service can create opportunities for orthodontic practices to gain greater flexibility over their fees and financial strategy. However, that does not mean it is the right decision for every practice or that every insurance contract should be eliminated.

The decision needs to start with a clear understanding of the numbers and the role each insurance relationship plays in the business. From there, practices can evaluate their operational readiness, prepare their teams, and develop a communication strategy that helps patients understand their options.

For some practices, maintaining certain in-network relationships may continue to make sense. For others, a gradual transition out of selected networks may better support their long-term financial goals.

The important thing is to make the decision intentionally. Know what each contract is costing the practice, understand the potential impact of leaving, and build a strategy that supports both the financial health of the business and the patients it serves.