--- title: "Out-of-Network dental practice: what it means for patients" description: "An out-of-network dental practice has no contract with a plan. See how the ADA describes PPO and EPO plans, what changes for patients, and what to ask." url: https://joncopeland.multisites.ai/blog/out-of-network-dental-practice publisher: Copeland Consulting Services email: drcopeland@joncopelanddds.com contact: https://joncopeland.multisites.ai/contact --- # Out-of-Network dental practice: what it means for patients An out-of-network dental practice does not hold a participating agreement with a patient's dental plan. In a PPO the patient may pay more but still get a benefit. In an EPO the plan pays no benefit. Practices should explain this to patients and check billing rules with an attorney. Practice managementPublished October 26, 20264 min read An out-of-network dental practice has no participating agreement with a patient’s dental plan. The patient can still visit the practice, but the plan treats the visit differently. This post explains the term using ADA sources, shows what changes for patients and billing, and lists questions to ask an attorney. It is general education, not legal advice. ## What does out-of-network mean? Out-of-network means the dentist has not signed up with the plan’s network. Being [out-of-network](https://joncopeland.multisites.ai/glossary/out-of-network) is the opposite of being [in-network](https://joncopeland.multisites.ai/glossary/in-network). An in-network dentist agrees to the plan’s rules and fees. The ADA notes that “when a dentist signs a participating provider agreement, they agree to abide by the dental plan’s processing policies.” An out-of-network dentist has made no such agreement. The term applies to a dentist and a plan together. The same practice can be in-network for one carrier and out-of-network for another. ## How do PPO and EPO plans treat out-of-network dentists? It depends on the plan type. The ADA explains that in a preferred provider organization (PPO) “the patient may incur greater out of pocket costs but would still receive a benefit.” In an exclusive provider organization (EPO), which the ADA also calls a “closed panel plan,” the plan pays nothing: “There is no benefit payable to an out-of-network dentist under an EPO plan.” Plan type Out-of-network visit What the patient may owe Source note [Dental PPO](https://joncopeland.multisites.ai/glossary/dental-ppo) A benefit is still paid Possibly more out of pocket ADA FAQ EPO (closed panel) No benefit paid The dentist’s full fee ADA FAQ The ADA adds that EPO plans were typically used by dental HMOs and are “starting to gain popularity with PPOs as a mechanism to control costs.” Plan designs change, so a practice should check each patient’s plan, not assume. ## What should the team tell patients? Clear talk at the start avoids surprises at checkout. The ADA writes that dentists “should be prepared to talk to patients about the repercussions of these types of closed panel plans.” It lists questions to cover: Does the patient understand that no benefit is paid for out-of-network care? Does the patient understand that the patient is responsible to the dentist for the full fee? A short checklist for the front desk: 1. Verify the patient’s plan and network status before the visit. 2. Explain in plain words how the plan treats this practice. 3. Give the patient a written estimate with the fee and any expected [explanation of benefits](https://joncopeland.multisites.ai/glossary/explanation-of-benefits) steps. 4. Send patients with questions about coverage to their plan or employer’s human resources team. The ADA says it is “always a good idea” for patients to do so, “especially before the employer makes a decision to switch the type of dental plan.” The glossary entry on [dental benefits](https://joncopeland.multisites.ai/glossary/dental-benefits) describes how plan types differ. ## How do fees work for an out-of-network patient? A practice that is not bound by a plan’s fee schedule sets its own [fee schedule](https://joncopeland.multisites.ai/glossary/fee-schedule). Rules on how to report fees still apply. The ADA Code of Ethics states: “The fee for a patient without dental benefits shall be considered a dentist’s full fee. This is the fee that should be represented to all benefit carriers regardless of any negotiated fee discount.” It also says it is unethical to increase a fee solely because the patient has dental benefits. State law, consumer protection rules and some payer rules can add limits on balance billing, fee disclosure and waiving patient shares. Ask an attorney how they apply to your office before you set your policy. ## What does a practice weigh before leaving a network? Leaving a network is a business decision. The ADA publishes a guide on terminating a network agreement for dentists who “are considering terminating the agreement.” The decision affects more than the plan’s fee list. Things to model with a CPA: - Which patients are covered by the plan, and how many might stay out-of-network. - How the schedule would change if some of them leave, and how fast new patients could fill the open time. - What the contract says about notice, treatment in progress and listing in directories. - How your team would explain the change to patients. Compare these against the same questions you asked when joining. The [dental PPO participation factors](https://joncopeland.multisites.ai/blog/dental-ppo-participation-factors) post lists the factors, and the [PPO participation decision guide](https://joncopeland.multisites.ai/guides/ppo-participation-decision) shows how to put numbers on them. Do not rely on a rule of thumb for “the right” mix of in-network and out-of-network patients. No published standard sets one. ## Why do patients care about network status? Patients often pick a dentist by plan, so network status affects how they find a practice. The ADA notes that dental plan design “drives coverage and access for employee oral health.” A practice that is out-of-network should be ready to explain value and costs without pressure. Pressure language and promises of savings can also create problems under advertising and ethics rules, so keep all patient-facing wording factual and have an attorney review it. Some practices pair an out-of-network position with their own in-house plan. The [dental membership plans](https://joncopeland.multisites.ai/blog/dental-membership-plans) post explains how those work. ## Next step Read the [PPO participation decision guide](https://joncopeland.multisites.ai/guides/ppo-participation-decision) for a framework you can adapt, and bring your contracts and numbers to an attorney and a CPA. To discuss practice finance topics with Dr. Jon Copeland, DDS, a general dentist in Wildwood, Missouri, [contact Dr. Copeland about consulting](https://joncopeland.multisites.ai/contact?topic=consulting). ## Frequently asked questions ### What does out-of-network mean in dentistry? It means the dentist has not signed a participating provider agreement with the patient's dental plan. The ADA notes that in a PPO the patient may incur greater out-of-pocket costs but still receive a benefit. ### Do all dental plans pay out-of-network dentists? No. The ADA says exclusive provider organization (EPO) plans pay no benefit to an out-of-network dentist, and the patient bears all costs of care. ### Should a practice leave its networks? The ADA publishes a guide on terminating a network agreement and says to weigh the decision as a business choice. Ask an attorney and a CPA to review your contracts and numbers first. ## Terms on this page - [Explanation of benefits](https://joncopeland.multisites.ai/glossary/explanation-of-benefits) - [PPO participation](https://joncopeland.multisites.ai/glossary/ppo-participation) - [Dental benefits](https://joncopeland.multisites.ai/glossary/dental-benefits) - [Code of ethics](https://joncopeland.multisites.ai/glossary/code-of-ethics) - [Out-of-network](https://joncopeland.multisites.ai/glossary/out-of-network) - [Fee schedule](https://joncopeland.multisites.ai/glossary/fee-schedule) - [Dental PPO](https://joncopeland.multisites.ai/glossary/dental-ppo) - [In-network](https://joncopeland.multisites.ai/glossary/in-network) - [ADA](https://joncopeland.multisites.ai/glossary/ada) ## Sources 1. [ADA: Dental Insurance Frequently Asked Questions](https://www.ada.org/resources/practice/dental-insurance/dental-insurance-resources/dental-insurance-frequently-asked-questions) 2. [ADA: Dental Insurance Contract Issues](https://www.ada.org/resources/practice/dental-insurance/dental-insurance-resources/dental-insurance-contract-issues) 3. [ADA: Principles of Ethics and Code of Professional Conduct (2026)](https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/about/principles/2026_code_of_ethics_complete.pdf) 4. [ADA: Dental Insurance](https://www.ada.org/resources/practice/dental-insurance) Written by Copeland Consulting Services and checked against the sources above on October 26, 2026. Rules, data and guidance change, so check the linked page before you act on it. ## Keep reading - [The PPO participation decision: data to pull, contract terms and questions to askA dental PPO contract trades a lower fee schedule for network status with a plan. The choice belongs to the practice owner, with an attorney and CPA. This guide gives no advice on joining or leaving. It lists how PPOs work, the data to pull by payer, the contract terms to read and the questions to ask.](https://joncopeland.multisites.ai/guides/ppo-participation-decision) - [How dental membership plans work for practices and patientsA dental membership plan, also called an in-office plan, has patients pay a fixed amount monthly or yearly. In return they generally get preventive care at no charge and discounts on other work. The ADA offers a toolkit for evaluating it, and state rules vary, so involve an attorney.](https://joncopeland.multisites.ai/blog/dental-membership-plans) - [Dental PPO participation: factors to weigh before you signJoining a dental PPO means agreeing to the plan's fees and rules in return for access to its members. The ADA advises reading and evaluating the contract fully before signing. Weigh fee levels, payment terms, plan rules and cash flow, and ask an attorney and CPA to review.](https://joncopeland.multisites.ai/blog/dental-ppo-participation-factors) - [DSOs and private practice: models, data and questions to askA dental support organization (DSO) manages some or all of a practice's nonclinical work, such as billing, marketing and human resources. ADA data show 16.1% of U.S. dentists were DSO-affiliated in 2024, and 27% of those under 10 years out of school. Each model has trade-offs.](https://joncopeland.multisites.ai/guides/dso-vs-private-practice-guide) - [Starting a dental practice: planning, funding and complianceStarting a dental practice means building the business from nothing: a plan, a startup cost list, funding from a lender, a licensed entity, a site, equipment, a team and compliance systems. The SBA publishes free planning tools. Cost depends on your plan, so get quotes. This guide is education, not legal, tax or financial advice.](https://joncopeland.multisites.ai/guides/starting-a-dental-practice) - [Buying a dental practice: steps, financing and due diligenceBuying a dental practice usually runs in six stages: define your goals, get financing, value the practice, sign a letter of intent, complete due diligence, and close. Lenders, attorneys and accountants each own part of the work. This guide explains the steps and lists questions to ask. It is not legal, tax or financial advice.](https://joncopeland.multisites.ai/guides/buying-a-dental-practice) ## Talk with Dr. Copeland [Contact Dr. Copeland](https://joncopeland.multisites.ai/contact)[Email](mailto:drcopeland@joncopelanddds.com)