Going Fee-for-Service Will Cost You Patients, but Fewer Than You Fear
There are five things that decide how many patients you might lose during a fee-for-service shift.
Yes, going out of network loses some patients, but how many is largely in your control. Five things decide it: how much of your base sits on the plan you’re dropping, whether you leave one plan or all at once, your referral share, the gap patients must cover, and whether the practice is ready to make the case. Four of those five you can shape before you move. Across 100+ practices Pain-Free Dental Marketing has worked with, none has gone back.
The honest answer is yes, going out of insurance will lose you money at first. A practice we work with that went fully out of network in 2024 put it to us plainly: they had lost patients, and they knew it was going to happen.
But “will I lose patients” is not really what is being asked. Patients leave every practice every year for reasons that have nothing to do with insurance. What owners are actually afraid of is the thing underneath the thing. They’re afraid that production drops, and does not come back fast enough to keep the practice steady while they find their footing.
What we can tell you
We do not have a verified attrition figure for network exits. We have seen ranges quoted, but a percentage that has been passed around a conference circuit or online is not evidence, and your practice is not the average of a number nobody has checked.
Across more than 100 offices we have worked with, we have never personally seen one that has gone back after shifting to fee-for-service. Nobody going back tells you the decision was survivable. It does not tell you it was comfortable, or that production held, or that the first eight months were anything other than unpleasant.
Going back is costly and a little humiliating, so a practice can regret the move and still not reverse it. Treat “nobody went back” as evidence that the cliff people imagine is not there, but don’t treat it as evidence that there is no dip.
What actually decides the number
- How much of your base sits on the plan you are dropping.
This is arithmetic rather than strategy, and it is the first thing to establish. A practice where one plan represents eight percent of active patients is having a completely different conversation from one where a single plan covers half the book. The second practice is not making a marketing decision at all; it is restructuring the business.
- Whether you leave one plan or all of them.
Dropping the worst-reimbursing plan while remaining in others is a manageable, reversible experiment with a bounded downside. Going fully out of network in one step is a different act. The practices we see do this well tend to take the plans off in sequence, which spreads the loss across periods the schedule can absorb.
- Whether your patients are there for you or for the directory.
The best available proxy is your referral share, and it is the reason we ask about it before almost anything else. A patient who found you because a friend insisted is far more likely to follow you out of network than one who found you by filtering a list of in-network providers by zip code. If around half your new patients arrive by referral, you have a base of people who chose the practice rather than the plan. If it is well under that, a large share of your patients are attached to something you are about to give up.
- The size of the gap they are being asked to cover.
Where your fees sit relative to your market, and what a patient’s out-of-network benefits actually reimburse, decides whether staying costs them a little or a lot. This is a question for a dental CPA.
- Whether the practice is ready to make the case.
Whether the front desk can answer the insurance question with something other than an apology. Whether there is a membership plan to offer. Whether the team can explain why the practice is worth it. These are covered at length elsewhere in this series, and they are the difference between a patient who considers staying and one who was never given a reason to.
The dip is real, but manageable
Notice that four of those five are things you can influence before you make a single move.
The patients leave on a timetable you control. The replacement production arrives on a timetable you do not. The gap between those two is the whole risk, and the practices that come through it well tend to have done the same things: taken plans off in sequence rather than all at once, held new-patient capacity open so the people who do come can be seen quickly, leaned on same-day treatment to convert existing patients into production without needing new ones, and put a membership plan in place before it was needed rather than after.
None of that is marketing. All of it is what determines whether marketing is worth buying afterwards.
What it looks like when it goes well
The practices that come through this describe the same shape. A few months quieter than they would like, a schedule that thins before it refills, and then a business that is smaller in patients and larger in almost every other respect, with more production per day, fewer days worked, and fees that arrive whole.
The ones who found it hardest were not the ones who lost the most patients. They were the ones who had not decided in advance what the quiet months would look like, and so read a planned dip as a mistake.
Get your numbers ready
You will lose patients. How many depends mostly on things you can measure before you start: what share of your base sits on the plan, how much of your book arrives by referral, and how big a gap you are asking people to cover.
Get those three numbers before you get an opinion, and be skeptical of any figure offered to you by someone who did not ask for them first.
On the other hand, if you’re ready for support to market your practice, we’re a call away.
Frequently asked questions
Will I lose patients if I drop a dental insurance plan?
Yes, some. Patients leave every practice every year anyway. But how many you lose over insurance is largely within your control, and it’s usually the fear of production dropping and not recovering fast enough that owners are really asking about, more than the headcount itself.
How many patients will I lose going out of network?
There’s no reliable industry figure, and any percentage passed around a conference isn’t evidence for your practice. What we can say: across 100+ offices we’ve worked with, none has gone back. Treat that as evidence the cliff people imagine isn’t there – not as proof there’s no dip.
What determines how many patients I’ll lose?
Five things: how much of your base sits on the plan you’re dropping, whether you leave one plan or all at once, whether patients are there for you or the directory (referral share is the best proxy), the size of the fee gap they’d cover, and whether the practice is ready to make the case.
How do I keep the patient loss manageable?
Take plans off in sequence rather than all at once, hold new-patient capacity open, lean on same-day treatment to turn existing patients into production, and put a membership plan in place before it’s needed. Patients leave on a timetable you control; replacement production arrives on one you don’t, and that gap is the whole risk.