Is Your Practice Actually Ready to Go Fee-for-Service
Published by Michelle Haupt on
By Megan Wyrick
Look, almost every practice owner I talk to is circling the same question. PPO reimbursements keep shrinking, overhead keeps climbing, and at some point, the insurance-driven model stops adding up. So they ask: should we go fee-for-service?
Honestly, that is the wrong first question. For a lot of practices, going fee-for-service is a smart move. The real question is whether your practice is ready for it. Because going out of network does not fix a shaky practice. It exposes one.
I walked through the full framework in my Cutting Edge Webinar with Ortho2, When to Go Fee-for-Service and How to Know if You’re Ready. Here is the short version: what fee-for-service actually is, the five things to look at before you decide, and the readiness check I run with practices.
What Fee-for-Service Really Means (And What it Does Not)
First, let’s clear up what we are actually talking about, because there is a lot of confusion.
Fee-for-service means you are not contracted with insurance companies. You are an out-of-network provider. You control your fees, your treatment modalities, and your treatment time. That control is the whole point.
Here is what it does not mean. It does not mean you stop accepting insurance or stop helping patients use their benefits. And it is not only for luxury or boutique practices running high fees at low volume. That is the biggest myth I hear, and it keeps good practices from even considering it.
Most practices do not flip a switch to full fee-for-service overnight. The common structures are full FFS, or a hybrid, where you keep a core PPO or two and move everything else off insurance. Hybrid is often where a practice starts.
Before You Decide, Look at Five Things
Before you decide anything, you have to know your own practice. These are the five things I have every practice identify first.
1. What type of practice are you today? Low fee and high volume, heavily in-network? Middle of the road, already hybrid? Or high fee and low volume, close to fee-for-service already? Be honest about where you actually sit.
2. Your competition. Are you the only practice within a 20-mile radius, are there 2 to 5, or are there 5 or more? The more crowded your area, the harder your value story has to work.
3. How patients find you. General dentist referrals, word of mouth, insurance, or ads and sponsorships? If insurance is the main reason patients land with you, that is a flag worth taking seriously before you leave the networks.
4. Your patients’ financial demographics. What percentage of your patients have insurance? How many pay in full versus monthly? How many need payment extensions or low down payments? How many are courtesy or discount-driven? This tells you how your base will react.
5. Your practice culture. Why would a patient choose you if insurance was not steering the decision? Your clinical outcomes, your team, your systems. If you cannot answer that clearly, that is the work to do first.
Here is the truth bomb I leave every practice with: fee-for-service exposes weak systems. It does not create them. If your collections, your scripting, or your follow-up are shaky now, going out of network makes that louder, not quieter.
The Readiness Check
Once you know your practice, run the readiness check. I break it into four areas, because a stumble in any one of them is where transitions go wrong.
Positioning. Are you genuinely confident in the move? You will not convert every patient, and that is fine. The goal is to convert the right patients. Do you have a steady flow of new patients from sources that are not insurance? If your pipeline depends on being in-network, fix that before you leave. The common mistake here is underestimating how much you leaned on insurance to justify your cost. Without a clear, differentiated value story, patients just price-shop.
Communication. Do you have a communication strategy, or are you going to spring this on people? Start by talking to the insurance companies so you know what to expect: payments rerouted to the patient, lower lifetime maximum payouts, and new claim processes. Then build the patient game plan, educate patients and parents early, and do not announce it abruptly. And do not skip your team. Your front desk has to be confident explaining what out-of-network means, and that you can still submit claims and collect for patients. No scripting equals confusion, and confusion drops case acceptance.
Financial. This is where the discipline lives. You need an exit strategy, not a switch. Do not drop all your insurances at once. Review your reports and fee schedule to decide which to drop first and when. One move makes this far smoother: quote your full fee and show the insurance discount on your contracts now, before you go out of network. Patients stop feeling a sudden jump, and pending patients convert more easily, because the insurance courtesy simply drops off once you are out of network. And build cash reserves for the short-term dip, because there will be one.
Emotional. Last one, and it matters more than people admit. Are you comfortable with short-term turbulence for long-term gain? Just as important, check your reason. Going fee-for-service because you are fed up with insurance, or because you heard a colleague did it, is not a strategy. The numbers and the systems make the decision, not the frustration.
The Honest Bottom Line
Fee-for-service can absolutely be the right move. For the right practice, with the right systems, it means more control, better margins, and a model that does not erode every time a payer renegotiates. But ready is the operative word.
And here is the part that sits underneath all of it. The day you go out of network, the money becomes yours to collect. The insurance check that used to come to you now routes to the patient, and your systems are what bring it in. Production means nothing without collections, and that is never truer than the day you leave the networks.
That collection side is the work my team does every day. If you want the financial engine airtight before you make the move, we run remote billing for orthodontic practices with a US-based team, working inside your existing software. Build the systems first, then go fee-for-service from a position of strength.
For the full framework, including the practice analysis and the financial steps I walk through, watch the Cutting Edge Webinar recording.
Megan Wyrick brings more than 15 years of hands-on experience inside orthodontic offices. As Co-Founder of The Wyrick Outlook, she helps practices move from reactive billing and collections to confident, repeatable financial systems. The Wyrick Outlook provides remote orthodontic billing and on-demand training for every seat in the practice.
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