Before You Drop the Network: The Math to Run First

Hamza Asumah, MD, MBA, MPH

Thirty-five percent of dentists say they plan to exit at least one insurance network within the next 24 months. Low reimbursement is now the single most-cited practice challenge, named by 55% of dentists — ahead of staffing, ahead of costs, ahead of everything.

The frustration is entirely legitimate. Reimbursement has not kept pace with inflation while overhead has climbed. You are the only party in the room who benefits from the discount you are giving.

But frustration is a poor basis for a structural decision, and this one is structural. Here is the analysis to run before you send a termination letter.

Start with the fear, because it is usually wrong

Most owners overestimate attrition badly. In one documented case, a $1.1M solo practice with 78% PPO patients dropped its two lowest-paying plans — plans covering 19% of the patient base and generating over $120,000 in annual write-offs. The dentist feared 45% to 50% attrition. Actual attrition was 31%, and net collections rose $87,000 in year two.

That gap between feared and actual is the most important number in this decision. Patients generally do not want to change dentists. They want to keep seeing the person who has treated them, and a meaningful share will absorb a higher out-of-pocket cost to do it — if you give them a reason and enough notice.

That said, 31% is not nothing. The decision is not “attrition will be trivial.” It is “attrition will be real, and the remaining patients may be worth more than the departed ones.”

The four-part model

Part one: rank your plans by profitability, not volume.

Pull your top 25 to 35 procedure codes. For each plan, compare the allowed fee to your full fee. Calculate the effective write-off percentage. Then multiply by volume to get dollars written off per plan per year.

You will almost certainly find that your plans are not equally bad, and that the worst one is not the biggest one. That is the whole point of the exercise.

Part two: identify the right first candidate.

The ideal first exit has four characteristics: reimbursement more than 40% below your standard fee schedule; fewer than 8% to 10% of your active patient base; failed negotiation attempts already on record; and limited alternative in-network providers nearby, which reduces where patients can easily go.

Resigning from a small, low-paying plan does minimal revenue damage while building the operational template — notice period, patient communication, billing transition — that you will reuse.

Part three: model chair-time value, not just fee difference.

This is the step most analyses skip. If you drop a plan and lose 30% of those patients, you free chair time. The question is what fills it. If your schedule currently has open capacity, you have lost revenue with nothing replacing it. If your schedule is full and you have a waiting list, you have swapped discounted work for full-fee work and the math improves dramatically.

Your existing chair utilization is the single biggest variable in whether dropping a network works. A full practice can afford to lose patients. A practice with open time cannot.

Part four: negotiate before you terminate.

The exit is not the only option, and it is not the first one. Fee negotiation is genuinely available and consistently underused. Pull your UCR comparison, gather regional benchmarks, document your cost inflation with specifics — staff wages, lab, supplies, compliance, technology — and make a case. Practices routinely secure 6% to 12% increases. That is margin with zero patient attrition risk.

If you are writing off 30% or more on your top codes and have never asked for an increase, you are not being underpaid by the carrier. You are being underpaid by a negotiation you decided not to have.

The retention mechanism you need first

Do not drop a plan until you have somewhere for those patients to land. An in-house membership plan is the usual answer — a flat annual fee covering preventive care with a discount on restorative. In the case above, the practice enrolled 84 patients at $299/year within six months of launch.

The sequencing matters: build the membership plan, market it to your existing base, then drop the plan. Reverse that order and you are asking patients to leave with nothing offered in return.

The hybrid option

You do not have to make one decision for the whole organization. A multi-specialty group can keep the general offices in-network while taking specialty — oral surgery, perio, higher-value procedures — out of network, because that is where write-offs do the most damage per procedure.

Segment by where the money is actually being lost rather than treating participation as an all-or-nothing philosophy.

Monday morning

1. Build the plan profitability table: every plan, effective write-off percentage on your top 25 codes, active patients on that plan, and total annual write-off dollars. One afternoon of work. Most groups have never seen this on one page.
2. Calculate your current chair utilization by location. If you are below 80%, park the network exit conversation and go fill the chairs you have. Dropping a plan while you have open time makes a bad situation worse.
3. Pick your worst plan by the four criteria and initiate a fee negotiation this quarter. Document cost inflation before you call. Even a failed negotiation strengthens a later exit — it becomes evidence you tried.
4. If you have no membership plan, start scoping one now. It takes months to build enrollment, and it needs to exist before any termination letter goes out.
5. If you do proceed, terminate one plan and hold everything else steady. Measure attrition for 90 to 180 days before touching the second. One variable at a time is the only way you will learn anything you can apply to the next decision.
6. Give patients 60 to 90 days notice, in writing, and train the front desk to explain it without apologizing — care does not change, claims will still be filed, out-of-network benefits still apply.

The honest caveat

There is a real macro variable here worth watching. Roughly 37 dental insurance reform laws passed at the state level in 2025, and broader coverage dynamics — including changes to marketplace premium subsidies — will affect what patients can absorb out of pocket. A patient population under affordability pressure attrites at higher rates than the historical case studies suggest.

Which is the argument for the disciplined version of this decision rather than the emotional one. Rank the plans. Negotiate first. Drop one. Measure. Then decide about the next.

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Sources: Clerri 2026 DSO growth trends (35% of dentists plan to drop networks); The Lead Magazine / ADA HPI Q4 2025 poll (55% cite low reimbursement as top 2026 challenge); ADA Health Policy Institute survey of 769 owner dentists on network exit plans; Dental Practice Insider (2026) case analysis on insurance dependency reduction (31% actual vs. 45–50% feared attrition; $87,000 net collections increase; 6–12% negotiated fee increases; $299 membership plan enrollment); Veritas Dental Resources PPO fee negotiation playbook (UCR comparison methodology); Cosmetics Growth 2026 analysis (≈37 state insurance reform laws in 2025).