Episode #345: When Should A Dentist NOT Go Out of Network?

Naren Arulrajah: This is the Less Insurance Dependence podcast show with my good friend Gary Takacs and myself, Naren Arulrajah.

Gary Takacs: We appreciate your listenership, your time, and most of all, we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal, professional, and financial satisfaction.

Naren Arulrajah: Hello everyone. Welcome to the Less Insurance Dependence podcast, the official podcast of the Reducing Insurance Dependence Academy, www.rid.academy. Membership to the Academy is a gift from Gary and I in appreciation for your listenership. Visit RID Academy and do not forget to register. By registering, you will have access to all of our resources and a free pass to all of our events, including our annual summit. I’m Naren, your co-host. Today’s podcast is titled, When Should a Dentist Not Go Out Of Network?

Before we jump into today’s podcast, um, I have a quick announcement to make. We have an event on the 8th of July, 2025. The topic is Delivering Next Level Patient Care: Creating Positive Experiences That Keep Them Coming Back. Go to thrivingdentist.com/events and do not forget to register. So it’s two hours of CE, July 8th, Delivering Next Level Patient Care, thrivingdentist.com/events. And the date is July 8th at 8:00 PM Eastern. Gary, um, any comments on this event?

Gary Takacs: Yeah, I’m excited about that, um, coming up. Um, you know, um, client service, patient service is an important aspect of successfully going out of network. And the great news is that many dental practices have set the bar pretty low in terms of patient service. So if you can be exceptional about how you provide—I’ll use customer service, the business term—that’s the term we’re more familiar with—if you could provide great customer service to your patients, you’re gonna stand out from the crowd. And it’s gonna create an environment where patients don’t want to go somewhere else, because somewhere else they’re gonna be treated, you know, in a much less favorable customer service climate.

So, a very important topic and I invite you all to come attend. Come join us. You’ll get a lot outta that panel. We’ve invited some experts to share their perspective on what patient service looks like, what exceptional patient service looks like, and you’re gonna get lots of takeaway information. Come join us.

Naren Arulrajah: Absolutely. I think it’ll be a great two hours. You’re gonna learn from a lot of experts, and of course, Gary. And you will be taking a lot of notes, so definitely don’t miss it.

Gary Takacs: And they get two hours of CE, correct, Naren?

Naren Arulrajah: That is correct. Two hours of CE on July 8th.

Gary Takacs: So you do need to register. You have to register to get your seat, but there is no tuition. That’s a courtesy that we’re providing to you in appreciation for your listenership. So go on thrivingdentist.com/events and register for that event and look forward to seeing you there.

Naren Arulrajah: Absolutely. Let me jump into today’s topic: When Should a Dentist Not Go Out of Network? I think it’s a great topic because yes, there are times—and I’ve heard you say this, Gary—where you have told people, looked them in the eye and said, "You shouldn’t do it." And I think it’s a good idea to talk about what are those reasons, and when have you told people. So if any of these are true for you, then you definitely should not go out of network. So I’m all ears, Gary. Let’s jump right in.

Gary Takacs: Yeah, I mean, I’d love to be the optimist that says, no, every dentist can go out of network. You all can do it. But in reality, if you step back and look at it objectively, it is not appropriate for every dentist to go out of network. It’s not. And in some of those cases, it could be, uh, very detrimental to your practice, you know, to go out of network. 

Naren Arulrajah: I mean, what—is it like they cannot ever go out of network or at this moment they can’t go out of network?

Gary Takacs: Well, I like to think of it more as a snapshot in time where at this moment their practice isn’t strong enough to. It takes a strong practice. You know, you think about when you’re in network, a whole lot of things are easier. When you’re in network —

"Hey, I have this free thing. Can I come to your office?" "Yeah, you can."

You don’t have to have great phone skills. "Yeah, I got a free coupon for a cleaning. Can I come in?"

Also, the likelihood they show up goes down, which is ironic because although it’s free, they place that much value on it — that it’s free, right? But everything’s harder. You’ve gotta communicate more effectively. You’ve gotta have more technology. You have to have more advanced clinical skills. You have to have a team that actually cares about your patients.

You have to have a lot of things in place to successfully do this. You’ve gotta have marketing in place. So, um, you know, if you don’t have those things, it doesn’t mean you couldn’t ever go out of network. But, um, it might be something you wanna think hard about — about whether you’re prepared and whether you’ve done the foundational work to be able to go out of network.

So let me, let me list just a few reasons — among many — when a dentist should not go out of network. I’ve got five that we’re gonna talk about in this episode. So let me number ’em one through five. They’re not numbered in order, but each one has, in my opinion, equal weighting. But I’ll number ’em.

So, number one is: If the practice is transaction-based. When I say the term transaction-based, what does that mean to you?

Naren Arulrajah: Um, transaction-based. Um, another way I would describe it is tooth dentistry — where they just come in, fix this, fix that. You’re almost like a, uh, you know, you go to those — I remember those places where you go to, uh, you know, fix your iPhone or buy an iPhone cover. You’ve seen those in your malls — kind of dingy and, you know, in the corner of somewhere where it’s not easy to find, you know, tiny off-place. And yeah, this guy doing stuff — that, to me, is a transaction. I have a problem, and, uh, you know, if and when I have it, I come there, I get it done, I never see you again in my life. To me, that’s—

Gary Takacs: Yeah. It’s kinda like — Naren, I know you’re not a car guy. I know you don’t get cars.

Naren Arulrajah: Yes.

Gary Takacs: But if you’re a car guy — and if you’re not a car guy, and you have an internal combustion car, not a toaster like you have, Naren — but if you have an internal combustion engine car that needs its oil changed, you might go to the quickie oil change, okay? That’s a transaction. But you don’t take your, you know, 1965 Porsche 911 to be restored at a quickie oil change.

Naren Arulrajah: Yeah, exactly.

Gary Takacs: It’s different. It’s different.

So what’s a transaction-based practice? It’s populated — it’s just a transaction. Patients probably don’t even know the dentist’s name. Dentist certainly doesn’t know the patient’s name. It’s just, "I have a toothache, fix it, and I’m outta here." Or, "I need my teeth cleaned. Let me do it." You know, it doesn’t matter who does it. "Let me just have my teeth cleaned."

Naren Arulrajah: Exactly. I’ve got a free coupon — if I can use it in your office, that’s good.

Gary Takacs: You know—

Naren Arulrajah: And it’s usually about price and convenience. And in this case, it’s free — great price and convenient. You know, known devil — you’ll do it for free, so who cares?

Gary Takacs: You know, and if you look at it on a spectrum — with one end of the spectrum being relationship-driven and the other end of the spectrum being transaction-based — the reality is rarely is a practice purely one or the other. But you fall somewhere in that range, from being more relationship-driven to being more transactional.

But if you have a transactional practice, you can make changes to be more relationship-based. What could we do? Simple things like starting to recognize patients’ names. You don’t have to know all your patients at all times by name, but you need to know the ones you’re seeing today. And maybe it’s doing an interview as part of the new patient experience — to get to know them a little bit better, to learn more about their dental history.

Gary Takacs: And now you’re starting to move over to the more relationship-driven practice. Um, and you don’t have to be completely relationship-driven, but the more you are, the more successful you’re gonna be when you go out of network — because people don’t want to leave a practice when they’re being taken care of by people who they know, like, and trust, right?

So, one reason not to do it is if you have a transaction-based practice. And maybe, doctor, it might be hard for you to see it, but maybe you could step back and try to look at your practice like it was a colleague’s practice — and what do you see? If you can be objective about it, what do you see? More relationship-driven? More transactional?

And I’ll tell you something — here’s a quick test. Um, how do you determine that? So, I’m gonna say this — doctor, here’s a quick test.

Gary Takacs: You could do — name five patients in your practice without looking in the chart, in your digital records, who are school teachers. Name five people in your practice by name who are first responders — policemen, firemen, paramedics. Name five people in your practice, without looking, who own their own business. Name five people in your practice who are retired.

And I don’t say you have to do all those. I did this recently with a potential client, and I asked him, "How relationship-driven do you think your practice is?"

And he said, "You know what? We’re not perfect. We can improve, but I think we’re pretty good at that."

And I said, "Do you mind if I test you?"

He said, "Sure."

And he failed all — all of those examples.

I said, "Can you name five school teachers?"

And he started to… and then… and he started thinking, "Well, um, she’s… she’s in her thirties…"

Gary Takacs: She, she, um, teaches fifth grade — no name, no name.

"Can you name five first responders?" "Uh, yeah… no."

"Can you name five people that own their own business?" "No."

"Five retirees?"

And then he said, "Well, I guess I’m not as relationship-driven as I thought I was."

There’s a quick test. See how you do. And I just chose those randomly. I could choose other categories. And I’m asking — without looking in your records.

Second reason when you would not want to go out of network is if the practice does not provide distinct reasons to the public on why they should choose your office for their care. The public understands. You’re not giving reasons to people to choose you.

What might those be? What might be some reasons that people would want to choose your practice?

Naren Arulrajah: So, you know, I think I really want to kind of emphasize something you said, Gary, on the first point — which is, if it is transactional, people can go anywhere, right? And if you’re gonna be honest, and if you’re willing to tell each other the truth, the only reason they’re coming to you is because you’re free. That’s it. You know, uh, I’m being blunt, right? Because why would they pay premium dollars and expect wonderful things when they see you as a transaction? Just the bare minimum. Like, I get—

Gary Takacs: When they see dentistry as a commodity. Yeah.

But here’s some reasons why people might want to come to you:

You have technology, right? You have technology, and there are some people — many people — that associate technology with a higher level of care.

You have a range of treatment options. Yeah, maybe not everything, but—

Naren Arulrajah: I do think relationship-driven is the number one reason, right? Like, if I were to—

Gary Takacs: All these could be good reasons, right?

Maybe you offer, you know, more of a one-stop shop, where patients can have many of their dental needs met under one roof.

I’m not a fan of convenient hours, but convenient hours would be a way to give patients a reason to choose you. The reason I don’t like the evenings and Saturdays is that it goes against the grain in terms of trying to establish a work-life balance between you and also your team members.

But that could be another reason, right? Why people might want to choose you.

Maybe it’s the orientation of the practice — maybe it’s a more biological practice, you know, more naturopathic, maybe more holistic in terms of treatment. Maybe it’s people that want that.

Maybe it’s a general dentistry practice that also does some really nice cosmetic dentistry.

Gary Takacs: Uh, maybe it’s an office that has a service like Invisalign, because people are interested in straightening — you know, crowding or spaces. So you gotta give people a reason to come.

If you can step back and say, "Are we giving people a reason to choose us other than it says dentist on the sign?" — then maybe we gotta start working on what those reasons could be.

Third reason is: Doctor and team members don’t have the communication skills to talk to their patients about going out of network.

The easy way out — and read my lips on this one, guys — do not do this. Do not do this.

The worst thing you could do in going out of network is simply send your patients a letter saying you’re going out of network. Worst thing you could possibly do.

We have to clean up that mess all the time in my coaching, because the office — they took the easy way out. They just sent the letter.

What do we need instead?

You have to actually talk to your patients face to face. You gotta talk to ’em about what you’re doing. And if you can’t do that, and your team members can’t do it, stay in network.

Now, I can train you. I can train your team members to do that — but we’ve gotta have the willingness to talk to your patients.

Gary Takacs: Sadly, some offices can’t do that. Number four, you have no marketing in place to replace the people you’re gonna lose when you go out of network.

That’s your world, Naren. But you know how true that is.

Naren Arulrajah: Yes.

Gary Takacs: You’ve got no marketing? You’re gonna lose patients.

Do we have marketing in place that will replace them with people that are choosing you for reasons other than you’re in their PPO plan?

Naren Arulrajah: And by the way, if somebody needs marketing help, I would recommend booking a Marketing Strategy Meeting. Uh, and the link for that is, um, thrivingdentist.com/msm.

So book the Marketing Strategy Meeting, and, uh, definitely, you know, lean in — because I agree. If you go out of network and you’re not replacing those patients you’re gonna lose, then your business is gonna shrink, and you’re gonna get nervous and stressed out.

Yeah.

Gary Takacs: Uh, and then fifth — and, um, I think all these are important, but this one certainly is important. I might even put it as number one if I’m asked, if I’m pressed — doctor and team members do not believe it can be done. They don’t believe it.

If you don’t believe it — if it doesn’t come out of your pores that you’re making the best decision you could make for your patients — then this simply isn’t going to work.

And it’s that Henry Ford quote: "Believe that you can, believe that you can’t — either way, you’re right." You’ve gotta believe it.

And sadly, there are — you know, when you’re on these, you know, there are many private Facebook groups, um, on Facebook, with some of them quite large — and a common, one of the most common topics discussed in those private dentist Facebook groups is: Does it make any sense to go out of network?

And what do you think the members of those private groups say, Naren? What do you think they say, generally?

Naren Arulrajah: It can’t be done.

Gary Takacs: Oh, no — "Worst mistake you could ever make!" Yeah. You know, "Oh my God…"

Naren Arulrajah: And I think it’s like — we become used to what’s around us, right? Like, you know, if everyone around us is, uh, you know, uh, a certain way, then we become like them. And you — you are like the five people you spend the most time with.

Gary Takacs: But there are — there are the opposite perspectives from dentists in those Facebook rooms:

"Best thing I ever did!" "You should consider it, but you gotta have some help, and you’ve gotta have the right plan."

Naren Arulrajah: I would recommend anyone who’s serious to join the Reducing Insurance Dependence Academy — RID Academy — because we have more than 1,500 members now, and they all are gung-ho on, you know, kicking the PPO plans to the curb and finding their own independence.

Some have finished the journey, many are in the middle, and some are just starting out. So you will find—

Gary Takacs: The power — the power of belief is amazing. Yeah.

Some of you know, if you’ve been a regular listener of the Less Insurance Dependence Podcast, I’m a runner. I’m a distance runner. I do marathons, half-marathons, and triathlons.

And, um, one of the coolest records in track and field history was the first runner to break the four-minute barrier in the mile. Roger Bannister did that on May 8th — so, around the time we’re recording this — 1954. May 8th, 1954.

Until then, sports psychologists, physicians, believed it couldn’t be done — that the lungs couldn’t carry enough oxygen, that someone could run that fast for that period of time to break the four-minute mile.

And then he did it. He ran it on May 8th, 1954 — three minutes, 59 seconds.

Gary Takacs: I think it was 3:59.4. So he beat it by, you know, a hundredth of a second, a few hundredths of a second.

And the world — the sports world — was absolutely jubilant about that.

And then, within two months, three other men broke the four-minute mile.

Why did they break it? Because they now knew it could be done.

And so I have some encouraging history — I have some encouraging comments related to that.

In my coaching work, we’ve helped over 400 practices in all 50 states, in every practice environment, do that.

We’ve broken the four-minute mile — using the analogy — over 400 times.

So if it’s been done before, it must be possible.

But if you don’t believe it, don’t bother doing it. Don’t bother. Don’t bother sticking your toe in the water.

Closing Thoughts

Gary Takacs: You don’t resign from PPO plans by sticking your toe in the water. You gotta be all in.

And belief is a powerful part of the whole equation.

Well, I hope you’ve enjoyed this Less Insurance Dependence Podcast. If you’d like to talk with me personally about whether it’s appropriate for you — or maybe you have some of these [issues] but would like to work on others — schedule a Coaching Strategy Meeting with me: thrivingdentist.com/csm.

That’ll open up my calendar — pick a time that works for you. You’ll meet with me on Zoom and we’ll sort this out.

And I won’t be shy. I’ll tell you if I don’t think it makes any sense — because I don’t want failures. But I’ll also tell you if I think you can do it.

Anyway, come join us.

On that note — thanks for the privilege of your time. Naren and I look forward to connecting with you on the next Less Insurance Dependence Podcast.