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Networking Doesn't Pay by Dr. Donald J. Roman

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Networking Doesn't Pay 

This Townie plans to be entirely out-of-network within 18 months— here’s what he’s done and seen so far

by Dr. Donald J. Roman

I’ve been practicing dentistry since 1983—the first few years as a commissioned officer in the Commissioned Corps of the U.S. Public Health Service, and in private practice ever since. In dental school, we had no formal business training, so we just went with the flow; if an office was a member dentist in insurance plans, we thought that was the norm. But the landscape has drastically changed, and we all face decisions about how the culture and business models of our offices will be established.

Physicians, for the most part, have been financially driven out of private practice and have become employees of hospital systems or groups run by corporate entities. In New Jersey, about 70% of the physicians are employed by corporations! To think that a similar thing won’t happen in dentistry is short-sighted or naive, so let’s take a look at our options and know that we can control the destiny of our profession and practices.

I’ll draw from my own experiences and history to give you a picture of the good choices (and poor ones) I’ve made over the past 35 years in private practice.


It’s all about playing the percentages
Dental benefits plans—I don’t refer to them as “dental insurance” because they don’t meet the definition of insurance, they’re a limited defined benefit—began in the late 1960s in California, and the yearly coverage hasn’t changed in more than 60 years! It was roughly $1,500 then and is still about the same. Just by taking in the cost of living adjustment, this should be around $16,000 in today’s dollars!

Benefits companies will tell you that by being a member dentist in their plan, you’ll be much busier, thanks to all of their patients. But on average, you’ll be discounting your customary fee by 35% or more. In speaking with my dental accountant, I learned that for every 5% you discount your fee, you’ll need to see 15% more patients to stay even with your UCR (usual, customary and reasonable) fees.

So, yes—with huge volume, you may be profitable, or changing how you manage your treatment plans may shield your losses. Unfortunately, it’s simply a numbers game and we can’t spend more on a patient’s care than we’re “allowed” to charge by being a member dentist. It is just a rush to bankruptcy ... or not.


Patients will pay more for quality care
We’ve all been fooled or intimidated to believe that we can’t be successful dentists unless we stay in-network with dental benefits plans. However, there are many patients who care enough about their health, function and appearance to trust their care to a dentist who considers their well-being regardless of their coverage.

Part of our job is to educate our patients and help them understand the importance and value in what we provide. I believe it’s better care to see patients for a longer appointment or an adequate visit than to see a schedule packed with patients—that’s higher stress on the team and doctor—and increase costs to provide that care. Patients appreciate the high level of care they’re given, rather than a rushed appointment. So, rather than accept a 35% or more discount in fees, start your own patient plan and give them 15% off their care. You just got a 20% increase in your fees, without seeing an additional patient!

The difficult step is to take your existing model of practice and begin the journey to being out of network (OON). We’ve found that, yes, you’ll lose some patients who are only concerned about the coverage—but many of those patients have begun to return to our office once they discover the care and service they’re getting at an in-network practice. When you’re sincere about the care you provide and the level of personal attention your patients experience, they’ll notice the difference and, if they value their health, they’ll return.

My practice is currently in network with only two member plans, and our goal is to be OON with them within 18 months. Our office has gone from 80% in-network patients to about 40%, and we’re still meeting our pre-drop goals—not bad!


Stop working so hard for approval!
Your choice whether or not to be a member of a dental plan doesn’t make you a good doctor or a bad one; it’s a personal choice about how you provide care to your patients. However, by being a member dentist, your hands are tied in the treatment you provide because if your treatment plan isn’t approved by the plan provider, you can’t bill the patient for treatment (unless you’d like to provide it pro bono). Is it really better to see large numbers of patients when you’re providing acceptable care but not optimal treatment?

I believe that providing dental care is difficult on a good day—when you’ve got one hand tied behind your back, it’s nearly impossible, and unfulfilling. There’s greater stress on us with our teams going through all the hoops of predetermination, which are not binding or a guarantee of payment or coverage. So why do we do it?


How you practice is up to you
One year after my practice dropped participation in one of the larger benefits plans, we’re still reaching our monthly goals and have more open time in our schedule. We’re now researching firms that could expand our social presence and target fee-for-service patients to fill the open time and push our goals even higher. My staff is far less stressed, and with the 30% increase in costs since the COVID-19 pandemic began, we are controlling costs and having much better days in the practice.

In my early years of practice, I worked like a dog, and I worked many of my good staff to the bone and burned them out, just because I didn’t know what I didn’t know. I made good money, but worked more than 55 hours a week chairside, including Saturday hours, leaving little time for my family and myself.

Don’t be afraid to choose your practice model—in or out of network—but always do your best for your patients. Despite what benefits plans tell you or their patients, we can all have a win–win situation providing great care, getting paid for what we provide and having grateful and happy patients. Let’s all work as colleagues and maintain the autonomy of our profession so it remains our right to choose how we practice.
Author Bio
Dr. Donald Roman Dr. Donald J. Roman, a member of Dentaltown’s editorial advisory board, has been in private practice in Bergen County, New Jersey, for nearly 40 years. He earned his dental degree from the Fairleigh Dickinson University School of Dental Medicine, then served as acting director of dentistry at the Camden County Family Dental Center before entering private practice. Roman is a fellow of the Academy of General Dentistry and the International Congress of Oral Implantologists, and an associate fellow of the American Academy of Implant Dentistry and the World Clinical Laser and Imaging Institute.
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October 2025
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