"Fee-for-service" gets used three different ways in dentistry, so it's worth being precise:
- An FFS practice — out of network with insurance plans. Patients pay your full fee and use their own out-of-network benefits. This is what most owners mean, and what this post covers.
- FFS vs capitation — being paid per procedure, rather than a fixed monthly amount per patient as with a DHMO.
- Medicaid FFS — the state pays per procedure directly, rather than through a managed care plan. Several states run dental Medicaid this way; see our state guides.
In-network vs fee-for-service at a glance.
| In-network (PPO) | Fee-for-service | |
|---|---|---|
| What you're paid | The plan's allowable | Your full fee |
| Write-offs | Fee minus allowable, every claim | None |
| Who pays you | Mostly the insurer | Mostly the patient |
| When you're paid | After the claim pays, often weeks | At the visit |
| Fee schedule | Set by each plan | Set by you |
| Claims work | Full claims cycle | Courtesy claims, if you offer them |
| New patients | Plan members find you in-network | Fewer; patients choose you |
Why practices go fee-for-service.
- You keep your full fee. No contractual write-off on every claim.
- No fee schedules to chase. Nothing to renegotiate every few years.
- Cash at the visit. Payment comes in on the day, not weeks later after adjudication.
- Less claim work. No in-network denials, downgrades or write-off reconciliation on your side of the ledger.
- More time per patient. Many FFS practices see fewer patients at a higher fee and book longer appointments.
The real downsides.
- Some patients will leave. Patients whose plan pays much less out-of-network may switch to an in-network dentist. Plan for it.
- Every fee is visible. Patients see the full fee and a bigger out-of-pocket, so case presentation and estimates have to be strong.
- Fewer new patients by default. You lose the plan directory as a referral source, so marketing has to replace it.
- Patient AR risk. If you don't collect at the visit, you're chasing patients instead of payers.
- Some plans pay the patient, not you. Out-of-network payments often go to the subscriber unless the plan honors an assignment of benefits.
What billing looks like in an FFS practice.
- Verify out-of-network benefits. Patients still want to know what their plan will reimburse. Check out-of-network coverage percentages, how the plan sets UCR, the annual maximum and frequencies — the same verification checklist applies.
- Give a written estimate. Your full fee, the estimated reimbursement and the patient's portion — signed before treatment.
- Collect at the visit. The full fee, or the estimated patient portion if you accept assignment.
- File courtesy claims. Most FFS practices still submit claims, with attachments, so patients get reimbursed quickly. Decide whether the plan pays the patient or, with an assignment of benefits, pays you. Some states require plans to honor assignment — including Maryland and, from January 1, 2027, California (self-funded ERISA plans are exempt). Check your state.
- Offer ways to pay. Payment plans, third-party patient financing, and an in-house membership plan for patients without insurance.
- Follow up on balances. Clear statements and consistent follow-up on anything not paid at the visit.
Is fee-for-service right for your practice?
Signs it can work:
- An established patient base that comes to you for you, not for your network status.
- Strong word of mouth and reviews bringing in new patients on their own.
- Most of your write-offs concentrated in one or two low-paying plans.
- A team comfortable presenting full fees and collecting at the visit.
Signs to wait:
- A newer practice still building its patient base.
- A large share of patients on a single employer's plan.
- No room in the budget to replace the plan directory with marketing.
It doesn't have to be all at once.
- Drop the worst plan first. Rank your PPOs by how far their allowables sit below your fees — the same analysis as renegotiating PPO fees. Sometimes a renegotiation fixes the gap without leaving.
- Check your contract. Each PPO agreement sets its own termination notice period.
- Tell patients early. Explain what changes, what their out-of-network benefits will cover, and what doesn't change about their care.
- Track retention. Watch how many of that plan's patients stay over the next 6–12 months before dropping the next one.
Where ZenHub fits.
Whether you stay in-network, go fully fee-for-service or land in between, the front office work doesn't go away. Our Front Office plan covers out-of-network verifications and patient calls without a billing contract, and our full-service billing covers practices that keep some networks. Weighing a move to FFS? Book a call and we'll look at your payer mix with you.