VIEWPOINT: Insurance-Free Dentistry 101

Written by: Linty John-Varghese, DDS
insurance-free dentistry


Ask for it all! Why not? We learned it, we yearned it, we earned it, we built it, and now we want it all. We’re done playing games and done cutting the pie into pieces for others to take away from us. We did the hard work; we should unapologetically get keep it all.

Dentistry is an artistic magnificence that integrates seamlessly with our body’s biology. But here comes the psychologic warfare, the emotional baggage of our patients, and the treatment limitations by insurance plans. No other profession can restore, replace, and rehabilitate structures within the mouth; create an alluring smile; correct a dysfunctional occlusion; and relieve debilitating headaches, all while managing personalities, expectations, and fears. Our intention is to make our patients feel and look great. We do miracles in confined spaces, building our finest masterpieces. I doubt we allow ourselves the credit for our craft and talent that we practice every day. Are we getting fairly compensated for our exquisite skills?

We work our fingers to the bone to create our perfect practice and to please our patients. Years later, everything hurts, and no one is happy. As we feel ourselves fall apart, we remedy it with massages, realignment by chiropractors, strength training by personal trainers, flexibility through yoga, meditation to quiet our rambling minds, and life coaches and therapists to manage our mental fatigue and anxieties. Then, when the pain gets intolerable, medications and surgeries come next, eventually followed by burnout or disability. How long should we endure this trauma? Nothing should be this hard!

The Insurance Gods

Many are slaves to the insurance gods. We know the best treatment for our patients and the right thing to do, yet we shy away from them because our hands are tied. We are scared to speak the truth, lest we scare our patients. Our teams spend an insane amount of time explaining insurance coverage to patients because we allowed the insurance companies to have their own representative minions at our practices. Little do we realize that we are controlled by the whims of Insurance Goons, who intentionally led our patients to believe that their treatment should be covered because they have “insurance.” Sounds like a free ticket to all dental treatment. If only they knew what they signed up for. 

It’s time that we ask for a different future. Dentistry should no longer be limited by insurance, and we should be rightfully compensated for our treatment. We should rebuild our happy practice and live the great lives that we deserve. As the saying goes, “Work smarter, not harder.” But how do we get there?


Going out-of-network with insurance companies is the first step to a different life. Welcome to new “freedoms” that you have never known: the freedom of not being tied to insurances, the freedom of not explaining coverage to patients, the freedom of having less staff as submission of insurance claims becomes a courtesy and not a necessity, the freedom in treatment without limitations, the freedom of choosing the patients we want to treat, the freedom of reducing our workload, the freedom of time to process our thoughts, the freedom of getting paid in full with no write-offs. We gave up all these freedoms a long time ago. Let me remind you, this is a choice. Choose well.

Often, we don’t realize that our own team members are responsible for teaching patients the value of insurance by emphasizing the “benefits of their covered procedures.” You have to wonder if we taught them this value or if they taught it to us. It is better to tell patients the truth and let them have the choice in their treatment than have the information fed to them by insurance companies or by our own teams. Pay attention because it is important to know what needs training to see an improvement.  

Why should we be tied down to unrealistic expectations of patients because insurance dictated the terms of their contracts? As we go out-of-network, we need to change our verbiage to retrain our patients. For example, “This is your bill for today. As a complimentary service of our practice, we will submit your bill to your insurance on your behalf. They may pay a portion of your treatment, if it is not declined. It would be nice if insurances paid more for your treatment, just as you pay your monthly dues. Sadly, they do not pay as much as you thought. You can always call your insurance provider to better understand what it pays. For any portion that is not covered or declined, you will receive a statement that is expected to be paid within 7 to 30 days. The ‘insurance contract’ is between you and your insurance company. If there is a discrepancy between what it paid us and what you expected, you have every reason to contact your insurance company. We will be happy to explain your statement after we receive it.” Do this with a cheery voice, a smile, and a charming demeanor with good, sincere intentions. Patients like honesty. It is very important to be as transparent as you can.

Patient Responsibilities?

This is how we handle the misery of dealing with insurance companies, then we go back to the patient. After all, they chose to sign up with them. Try not to make it about money or how your practice handles insurance; instead, make it about the patient’s treatment based on clinical and radiographic findings. No one in the office should use the word “insurance” or give it importance unless deemed necessary in conversation that is initiated by the patient. It is always their choice to make the right decision for treatment. Our own hindrance is that, for years, insurance companies have seared it in us to believe that we will fail without their alliance to keep us busy or be successful. In return, we owe them our allegiance and loyalty.

Why go out-of-network with insurance companies? The answer is simple: We want to offer the best treatment plan for our patients without being limited by insurance based on their “coverage” and “maximums” for the year. It is better to remove the gate and void the deals that the insurance companies offer to us or our patients. They force us to write off the value of our treatment to the amount they want to profit from us. We did not get to this point in life to be controlled by anyone. We should be paid in full for our services provided.

Many insurance companies have out-of-network benefits. Most patients are unaware of this, and we have an opportunity to train them. If the insurance company pays us more toward treatment, a refund check should be sent immediately. Patients love getting money back. It’s always better to overquote and collect more than underquote and chase balances. It is easier to train new patients by establishing a culture of collecting a deposit at the time of a new patient’s first appointment. Train patients to prepay all or a portion of the bill prior to treatment, and you will have less cancellations. Soon there will be a dramatic shift in the culture of your practice and the kind of patients you attract. There are many who love personalized service and attention and are willing to pay for your elite services. Learn to attract what you desire. Build a whole new world. 

Train your teams to brainstorm through blocks. Reward your team when you do well because you have no write-offs. There will be more enthusiastic participation when teams see the beneficial impacts of the new changes. They will work less, be less tired, and feel more successful. Build their confidence, empower them, and watch them grow into superstars. At the same time, some team players cannot come on our next journey because they are unwilling to change. Some tough decisions are necessary for your practice to move on. 

Take a Chance—Be Brave

Be ready to let your insurance-driven patients leave; this opens space for new patients. You will be doing a favor for yourself and your team. Worrying about what patients think will always keep us their prisoners. We are who we are. No one else can be us or make them feel the way we do. It is not possible to please everyone, and our worth should not be based on patient insurance benefits. If we let go of attachments and expectations, we will allow new things to come. Work on growth and ways to change your current mindset. Give yourself grace and patience to go through uncomfortable phases, which will take you to the next level.

Remember your “why”; you need a reason for your action. Create a timeline and deadlines for the changes you want to see. Craft a step-by-step plan of action to make them your new reality. This includes seeking guidance from mentors who have transitioned successfully, intentional planning and strategizing, sequential execution, and constant surveillance of systems that are newly implemented. Watch your practice turn fee-for-service before your very own eyes. We all deserve to live our best lives. We can all do hard things, and that’s the truth.


Dr. John-Varghese graduated from the New York University College of Dentistry in New York, followed by a GPR at the VA Medical Center in Dayton, Ohio and worked at the Wright Patterson Air Force Base in Dayton. She has been in private practice in Dayton since 2012, where she transitioned from a PPO to an FFS concierge practice in a short time with a focus on full-mouth rehab, cosmetics, sleep, and biological dentistry. She blogs at Lintys LEGIT List and trains dentists and their teams to strategize their transition to OON/FFS practices through a 4-week training program, “Insurance-Free Dentistry 101.” She can be reached at 

Disclosure: Dr. John-Varghese reports no disclosures.