Here is a number worth sitting with before any practice drops its first insurance plan: 1,200 to under 300. That is what happened to the active-patient count of a real practice that decided to leave a network. Not because leaving insurance is dangerous. Because of everything it did at the same time.
In the same stretch that this practice dropped the plan, it also raised its fees, changed how it handled assignment of benefits, changed its clinical protocols, and mailed every patient a cold letter that read like the practice already knew better than they did. Any one of those changes, on its own, is something patients can absorb. Stacked together and delivered all at once, they didn’t just lose a network contract. They lost the trust that was keeping the schedule full.
The myth this number kills
The story that spreads in dental circles about a case like this usually gets the lesson backward. It gets told as proof that dropping insurance is what wrecks a schedule, so the safer move is to keep every plan and just live with the write-offs. That reading doesn’t survive contact with what actually happened. The plan drop was one decision among five. The other four had nothing to do with insurance at all, and together they did more damage than the network exit ever could have on its own.
The real lesson is about pace, not about insurance. A practice that changes everything a patient can notice, in the same few weeks, is asking every one of those patients to re-evaluate the whole relationship at once. Most people don’t do that calmly. They leave, not because any single change was unreasonable, but because too much changed for anyone to explain it to them before it landed.
What one change at a time actually looks like
The alternative is not slower courage. It’s a sequence. Patients hear about a coming change 60 to 90 days before it happens, not the week it happens. One plan gets dropped, and the practice lets things settle before touching anything else. Fee changes, clinical protocol changes, and front-office process changes each get their own window instead of arriving in the same envelope as the insurance news.
Handled this way, a patient only ever has one thing to make sense of at a time, explained to them in advance by a team that expected the question and had an answer ready. That is a completely different experience from opening a letter that announces a network exit, a fee increase, and a new billing process on the same page, from a practice that has never mentioned any of it before.
Why the letter matters as much as the sequence
The tone of that communication carries almost as much weight as its timing. A letter that reads as an announcement handed down to patients lands differently than one that treats the change as something the practice is explaining to people it wants to keep. The ADA’s own sample documentation for practices gives a sense of the standard worth aiming for: its sample financial policy statement lays out exactly what a patient owes and why, in plain, matter-of-fact language, with space for the patient to sign and confirm they understood it. That is the register a practice wants in every piece of paper it hands a patient through a transition: clear about what is changing, plain about why, and never written as though the patient should simply trust that it’s fine.
A cold, one-way letter does the opposite. It tells patients the decision has already been made and their only role is to accept it. Combine that tone with several changes at once, and a practice has given its patients every reason to leave and no chance to ask a question first.
What this means for the practice weighing its own first drop
None of this is an argument for keeping every plan out of caution. It’s an argument for controlling exactly one variable at a time so a practice can actually tell what is and isn’t working. A practice that drops a plan on its own, with nothing else changing, can watch how patients respond to that specific decision. A practice that bundles five changes into one season learns nothing except that patients left, with no way to say which of the five decisions did it.
Internal planning at Fee for Service Academy treats attrition on a dropped plan as something to plan for, not something to fear or promise away: expect some patients to leave, expect fewer than feared when the change is handled well, and never treat a specific number as a guarantee, because every practice’s mix of patients is different. What is consistent across practices is the mechanism that keeps the number low. Prep the patients, drop one thing, let it settle, and only then move to the next. The practice that fell from 1,200 to under 300 patients did none of that. The practices that keep the bulk of their patients through a transition do exactly that, one change at a time.
Sequencing a transition this way, plan by plan, is the core of the work Fee for Service Academy does with practice owners before anything gets cancelled.