When a dental practice transitions from being in network to out of network with an insurance provider, it can create uncertainty for patients. This change impacts how claims are processed, how payments are collected, and how much patients pay for care. Without a clear and timely communication strategy, misunderstandings can occur, potentially leading to cancellations or loss of patient trust.
One of the most effective ways to address this change is by sending patients a well-crafted notification letter. This letter should explain the change, outline how it affects the patient’s insurance benefits, and provide clear instructions for next steps. With the right approach, you can help patients understand their options and maintain their relationship with your practice.
Why a Patient Letter Is Essential
An out of network notification letter serves several purposes:
-
Transparency: Patients appreciate honesty about changes that impact their care and finances.
-
Education: Many patients do not fully understand how dental insurance works, especially out of network benefits.
-
Retention: Clear communication reduces the risk of losing patients to other providers.
-
Operational efficiency: It decreases the number of repetitive phone calls to your front desk.
By proactively sending this letter, you give your team more control over the message and help maintain patient loyalty.
Core Elements of an Effective Letter
A successful out of network notification letter should be clear, concise, and patient-focused. Here is what it must include:
-
Effective date of the change so patients know when their benefits will be affected.
-
Reason for the change framed positively, such as focusing on quality of care or operational improvements.
-
Reassurance that patients can still receive care at your practice.
-
Details on claim filing and whether you will accept assignment of benefits.
-
Payment policy changes and information about financing options.
-
Contact details for patients to ask questions or request an estimate.
-
Encouragement to schedule a benefits review before upcoming appointments.
The tone should remain professional, warm, and free from industry jargon. Avoid blaming the insurance company or making the letter sound confrontational.
Timing and Workflow for Notification
Planning ahead is essential. A smooth transition from in network to out of network status involves three phases:
Pre-Notification Phase
This phase should begin months before the change. Ideally, start planning six months in advance if possible. Tasks include:
-
Drafting the patient letter and an FAQ sheet.
-
Reviewing state requirements for insurance changes.
-
Preparing front desk scripts for phone and in-person conversations.
-
Identifying patients with active treatment plans or pending authorizations.
Notification Phase
This is the time when you actively communicate with patients:
-
Mail printed letters to all active patients on practice letterhead.
-
Send email notifications to supplement the mailed letter.
-
Post an announcement on the practice website and in the office.
-
Offer individual benefits reviews for patients with upcoming procedures.
-
Train staff to answer questions consistently and calmly.
Post-Notification Phase
Once the effective date arrives:
-
Continue to submit claims for patients when permitted.
-
Ensure cost estimates reflect the new out of network status.
-
Monitor denials and reimbursement delays closely.
-
Maintain ongoing communication with patients about their benefits.
Billing and Coding Considerations
From a medical coding and prior authorization standpoint, moving to out of network status changes how insurance claims are processed.
Assignment of benefits
Many insurers will reimburse the patient directly rather than the provider once you are out of network. Some states have laws requiring insurers to honor assignment of benefits if the patient requests it. Practices must decide whether they will continue to accept assignment or require payment at the time of service.
Patient responsibility estimates
Accurate cost estimates are essential. Estimates should include:
-
The procedure code and description.
-
The full fee charged by the practice.
-
The insurer’s estimated allowable amount.
-
The portion the patient is responsible for.
Preauthorizations
For ongoing treatment, check if existing preauthorizations remain valid after leaving the network. In many cases, a new preauthorization may be required. This is particularly important for major procedures like crowns, dentures, and orthodontic treatment.
Example Out of Network Notification Letter
Subject: Important Update About Your Dental Insurance and Our Office
Dear [Patient Name],
We value the trust you place in us for your dental care. We are writing to inform you that as of [Effective Date], our practice will no longer be a participating provider with [Insurance Company Name].
You may continue to receive your dental care at our office. We will continue to file claims on your behalf when possible. However, because we will be out of network, your plan may reimburse you directly, and your out-of-pocket costs may change. We will provide a written estimate before any treatment so you know exactly what to expect.
If you are currently undergoing treatment, please be assured that we will work with you to maintain continuity of care. Our team is happy to review your benefits, answer your questions, and discuss payment options if needed.
For any questions or to schedule your benefits review, please call us at [Phone Number] or email us at [Email Address].
We appreciate your trust and look forward to continuing to provide the highest quality care for you and your family.
Sincerely,
[Provider Name]
[Practice Name]
[Contact Information]
Internal Office Checklist for Managing the Transition
| Task | Responsibility | Deadline |
|---|---|---|
| Draft letter and FAQ document | Provider & Office Manager | 6 months before change |
| Verify state laws on assignment of benefits | Billing Manager | Immediately |
| Identify patients in active treatment | Clinical Coordinator | 5 months before |
| Train staff on scripts and FAQs | Office Manager | 3 months before |
| Send first batch of letters and emails | Administrative Team | 60 days before |
| Post office and website notices | Marketing | 30 days before |
| Follow up with high-risk or high-needs patients | Clinical Team | Ongoing |
Scenarios and Best Practices
Patient with treatment mid-progress
If a crown or other multi-step procedure is already underway, confirm whether the insurance will honor the original authorization or whether a new approval is needed.
Patient with minimal out of network coverage
Provide an itemized estimate and discuss alternative solutions such as in-house membership plans or payment arrangements.
Patient unsure about staying with your practice
Emphasize the value of continuity of care, the familiarity with their dental history, and the personalized approach your office provides.
Frequently Asked Questions
Will my insurance still cover visits at this office?
Most plans have out of network benefits, but the coverage amount and patient cost may be different. We will help you understand your benefits before treatment.
Will I have to pay at the time of my visit?
If your plan does not allow direct payment to our office, we will require payment at the time of service, and your insurer will reimburse you directly.
What if I want to switch to a dentist in my insurance network?
You are free to do so. We will provide your dental records to ensure a smooth transition.
Will my preauthorization still be valid?
Some preauthorizations are tied to in network status. We will review each one and obtain a new authorization if needed.
Final Professional Insight
From a billing and prior authorization perspective, clear communication and proactive planning are the keys to a successful transition. Notifying patients early, providing accurate cost estimates, and training your staff to handle questions with confidence will protect your patient relationships and minimize disruption to your schedule.
A thoughtful, well-prepared letter is not just a courtesy—it is an essential business tool. When combined with consistent follow-up, it reassures patients that their care remains your top priority, even as insurance relationships change.