A fee-for-service dental practice sets its own fees and is paid directly by patients at the time of service, rather than accepting a payer's contracted rate as payment in full.
This page is the practice-owner view of that model inside dental marketing as a whole: what fee-for-service means for your revenue mix, why practices drop PPO networks, how a transition works, and where the trade-offs land.
The term gets used two ways, so one definitional note first: here it means a practice that operates out of network and bills patients at its own fee schedule, not the government-program sense of fee-for-service claims.
What is a fee-for-service dental practice?
A fee-for-service dental practice is out of network: there is no participation agreement with a dental insurer, no payer sets the allowed fee, and the practice's own fee schedule is the price.
The in-network version works differently, and the difference is contractual: when you sign a PPO participation agreement, that payer's fee schedule becomes your allowed fee for covered services, the plan pays its share, the patient pays theirs, and the gap between the allowed fee and your fee is a write-off.
Fee-for-service removes the contract: the patient pays your posted fee at the visit, and any reimbursement from their plan is an out-of-network question between the patient and the insurer, not a rate you agreed to.
Most practices sit on a spectrum rather than at a pole, because the average 2025 billing mix for owner GPs was 50.0% from private insurance carriers, 40.2% directly from patients and 7.3% from government programs, per the ADA Health Policy Institute's Survey of Dental Practice.
The patient mix tells the same story: an average of 66.9% of patients in GP practices had private insurance in 2025 and 24.8% had none, so most practices already run a hybrid of contracted and self-pay care.
Going fee-for-service is therefore a question of degree: drop one network, drop several, or leave them all, and each step moves more of your book onto your own fees.
Dropping PPO dental: the numbers behind the exit
The squeeze is measurable: per the ADA Health Policy Institute, over the past five years prices for equipment, supplies and staff wages rose 23% while reimbursement across all payers rose 19%, and GP inflation-adjusted income has declined over 15 years.
Dentists are acting on it: in a February 2023 ADA Health Policy Institute panel poll of 1,164 dentists, 16% said their practice had dropped out of at least one insurance network since January 1 of that year, and another 21% said they intended to within three months.
The scale matters for planning: among practices that dropped a network, the networks they left held an average of 17.5% of the patient base.
The write-off line is where the decision usually starts, and it is arithmetic you can run on your own data.
The per-visit write-off on one covered code
Annualize one code and the number gets loud: if a dropped payer covers an illustrative 20% of the 800 crowns your practice delivers in a year, that is 160 crowns times $400 of write-off, or $64,000 a year given up on a single procedure code.
The other side of the ledger is real too, because networks deliver patients: the honest version of this decision weighs the write-offs against the new-patient flow the network steers your way, using your own management data rather than anyone's rule of thumb.
Going fee-for-service: how the transition works
A transition done well is mostly data work and communication, and it happens in roughly this order.
1. Pull the payer data
2. Rebuild your fee schedule
3. Build the landing pad
4. Tell patients before the change
5. Watch the numbers monthly
Stated intent is not the same as a signed termination, so treat any exit as a modeled decision, one network at a time, with your own numbers rather than the industry averages above.
Dental insurance vs fee-for-service: the trade-offs
Run side by side, the two models trade the same four things: who sets the price, who the patient pays, what happens to your fee, and where demand comes from.
In-network PPO
- The payer's fee schedule sets your allowed fee for covered services
- The gap to your posted fee is a write-off on every covered code
- Patients keep their in-network benefits, and the network steers patients your way
- Your pricing freedom lives outside the contract's covered codes
Fee-for-service
- Your fee schedule sets the price, and patients pay it at the visit
- No contracted write-offs on care you deliver
- Insured patients can seek out-of-network reimbursement from their plan, where the plan allows it
- Demand has to come from your reputation, reviews, local search and referrals instead of the network's directory
The honest downside is access to insured patients: 56% of Americans had private dental insurance in 2023, per ADA Health Policy Institute analysis of federal survey data, and price sensitivity is measurable too, because 13% of Americans said in 2023 that they skipped needed dental care because of cost, against 4% to 5% for any other type of health care.
The honest upside is control: no contracted write-offs and a fee schedule you can actually change, which is exactly the lever the 23%-versus-19% cost squeeze puts under pressure.
That pairing is why the exit and the membership plan usually travel together: a plan turns a dropped-network patient into a direct subscriber at your fee schedule instead of a stranger to the practice.
A fee-for-service dental practice is not a verdict, then, but a pricing posture, and the right mix depends on your payer book, your case mix and your market, where your own data should outvote any article, including this one.
Marketing a fee-for-service practice
Once the pricing posture changes, the website's job changes with it: an out-of-network practice has to answer price, membership and financing questions on the page, because the patient is making a bigger out-of-pocket decision than an in-network competitor asks of them.
Fee-for-service conversion work is mostly clarity work: the membership plan on its own page, financing options stated before the call, and a booking form that does not hide the fee conversation, all of it covered in the dental website conversion checklist.
The conversion half is the craft I know best: as Director of CRO at LaserAway from 2018 to 2023, I ran the testing program that took sitewide conversion from 3% → 11% across 2,600+ variations, and the same test-one-change discipline applies to a fee-for-service page.
If you want the leaks found before you commit to the model, the free audit returns a prioritized findings doc within 3 business days, no call required.
Frequently asked questions
What is a fee-for-service dental practice?
A practice with no payer contracts that sets its own fees and is paid directly by patients at the time of service. The practice's fee schedule, not a network's, is the price.
Does fee-for-service mean patients pay the full fee at the visit?
Patients pay your posted fee rather than a contracted rate, and most fee-for-service practices collect at the time of service. Many also offer financing and membership-plan pricing, which changes what the full fee means for the patient.
Can a fee-for-service practice still treat patients who have dental insurance?
Yes, as out-of-network patients: they pay per your fee schedule and can seek reimbursement from their plan where its out-of-network benefits allow. Whether they get paid back is a question between the patient and the insurer, not a rate you agreed to.
Is dropping one PPO the same as going fee-for-service?
No: dropping one network moves only that network's slice of your patient base onto your fees, while full fee-for-service means leaving networks altogether. In a February 2023 ADA Health Policy Institute poll, the networks practices dropped held an average of 17.5% of their patient base.