A patient with out-of-network benefits comes in, gets excellent care, and leaves. A few weeks later the plan processes the claim and sends the reimbursement to the patient. Now someone at your front desk has to call that patient and collect a fee the practice already earned, from a person who believes the bill has been settled.
Every office that sees out-of-network patients has lived some version of that call. It is uncomfortable on both ends of the phone, and the person making it usually did nothing wrong. The good news is that the call is almost always decided much earlier, in paperwork and a conversation that happen before anyone sits in the chair.
The myth: the plan paid the patient, so the fee is out of your hands
When the money lands in the patient’s account instead of yours, it can feel as if you have lost control of your own fee. You have not. You still set the fee, and you are still entitled to collect it.
The ADA said as much this spring. In a Dear ADA column on out-of-network billing, written by Mary Beth Versaci and published in ADA News on May 22, 2026, the answer came from Lindsay Compton, D.D.S., a member of the ADA Council on Dental Benefit Programs. She reminds dentists that in an out-of-network situation the patient’s benefits relationship is with the payer, and that the dentist is entitled to the full fee as remuneration from the patient. In the same breath she adds something worth repeating to your team: patients with out-of-network benefits should be told clearly that they are still welcome to receive care at your office.
The same column opens with a figure that explains why this lands on so many desks. In an ADA Health Policy Institute poll in late 2025, more than half of dentists said one of their top concerns heading into 2026 was related to insurance, including low reimbursement rates and delayed or denied payments.
Why the patient is surprised in the first place
Dr. Compton’s starting point is the patient, and it is a generous one. She writes that offices should begin by recognizing that most patients misunderstand their out-of-network benefits. Patients often assume the financial side works the same way it does in network. Some believe they are only allowed to see an in-network dentist at all.
Put yourself on the other side of the counter for a moment. A patient who has only ever been in network has never had to think about who the plan pays, or what happens to the difference between your fee and the plan’s allowance. Nobody explained it, so they arrive holding the in-network picture. When the plan’s payment reaches them, it can look like a refund. Your call feels like a second bill.
That is a knowledge gap, and a knowledge gap is the easiest kind of problem a front desk ever gets to solve. It just has to be solved at the right moment.
What the ADA recommends, and when
The column is specific about the timing. The office team should clearly communicate the practice’s network status, give patients a written financial policy, and explain that while the office may submit claims as a courtesy to help maximize available benefits, the patient remains responsible for the balance. Having patients sign acknowledgements that they understand those expectations can reduce confusion and disputes. All of it should happen before treatment and, as a best practice, during intake.
Dr. Compton adds several practical points that belong in any out-of-network office’s playbook. A pretreatment estimate is not required, but it helps, and for an out-of-network dentist it should be based on the full fee. The estimate should say plainly that it is a courtesy, based on information from the insurance company, and not a guarantee of coverage or payment. It should also say that the patient remains responsible for the full fee even if the office is willing to wait while the plan adjudicates the claim. And if the plan’s explanation of benefits shows the patient’s responsibility as zero while the plan has not paid the dentist’s full fee, or has applied fee limitations, the ADA’s position is that the explanation of benefits is incorrect and should be challenged.
She also makes a point that is easy to skip. Because out-of-pocket costs may be higher out of network, the conversation should stress the importance of the patient’s care and the expertise behind it. Her point is that this emphasis helps the patient see the value of care beyond doing only what insurance covers.
The paperwork already exists
Many offices never see them, but the ADA publishes sample forms that put the conversation in writing, and both are free to download.
The first is the ADA Sample Financial Policy Statement, copyright 2015. It opens with the whole mechanic in one sentence: payment for services, including deductibles and copayments, is due at the time of service unless other arrangements have been made before treatment. Its insurance paragraph, which is where it tells the patient they are ultimately responsible for all charges, is written for a practice that accepts dental benefit plans. A fee-for-service office edits that paragraph to match how it actually works.
The second is the ADA Sample Consent Form: Service(s) not paid for by the Benefit Plan, copyright 2018. This is the one that names the exact situation in the patient’s own paperwork. The form tells the patient, above the signature line, that they are “responsible for all charges including when the dental plan chooses to reimburse you directly.”
Read it closely before you adopt it, though. Like the financial policy, it is written as a template for a practice that accepts a named plan, and some of its language assumes a contracted relationship. An out-of-network office will need to adapt it, not simply print it.
The fine print that travels with both forms
Two caveats belong with these documents every time they are mentioned. First, the ADA permits reproduction by ADA member dentists and their staff, and any other use requires the ADA’s prior written approval. Second, both forms state that they are educational only, do not constitute legal advice, and may not satisfy applicable state law. Have the practice’s own attorney review whatever version you put in the intake packet. That review is a one-time cost, and it protects every conversation that follows.
ADA members who run into a specific dispute can also contact the ADA’s Third Party Payer Concierge, which the column describes as complimentary help with dental insurance questions and issues.
Move the conversation to intake
Here is the practical shape of it. At intake, in person, the patient hears the practice’s network status, reads a financial policy written for an out-of-network office, sees an estimate based on the full fee, and signs an acknowledgement that covers the case where the plan reimburses them directly. The whole exchange takes a couple of minutes while everyone is relaxed and the estimate is on the counter.
Handled that way, a plan check arriving at the patient’s house is simply the next step the patient was told to expect. Handled at checkout, or weeks later by phone, the same event turns into collections. The facts are identical in both versions. Only the timing changed.
This is where the front desk earns its keep. In an independent practice, the intake packet effectively is the billing department, and the person who owns intake owns this outcome. Give that person the forms, the script and the backing of the doctor, and the hardest call of the week mostly stops happening.
Team scripting, and the patient conversations that come with leaving insurance plans, are part of the work Fee for Service Academy does with practice owners and their teams. If you want to see whether your practice is a fit, that is the place to start.