How To Start or Create a Fee For Service Dental Practice

How do you start, or transition to a fee for service dental practice?

This is a great question and there’s no right or wrong answer, but it really just depends on your goals and what you want to accomplish. First, we typically suggest practices put together that we call a 1-Page Practice Growth Plan (PGP).

It’s simply a single sheet of paper with two sides printed on it. On your PGP, you’ll put your goals for this year, your goals for the next 3 years and your goals for the next 10 years. Then, from those goals, you’ll work backwards and decide what you want, who you’re going to involve and the (Big Why) purpose behind why you’re doing it.

The biggest and most important use of your time in this exercise is to sit down and put a pen to paper, and ask yourself “what is the purpose of your practice?” 

Don’t be mistaken…

You DON’T want to create a patient driven practice, a doctor driven practice, or even an insurance driven practice. That’s right, I said “DON’T!” 

Why you may ask? 

Because what will really drive you, and give your team meaning is when you develop a purpose driven practice. All those other resins are important, but they’re not as important as your Purpose.

So if you’re going to set up a fee for service practice, you need to first decide and write out your mission and why you want to have a fee for service practice. Because a lot of dentists that I’ve met over the years have good intentions. They often say, “well, we don’t want to be insurance dependent and we want to do what’s right for our patients.”

But then the real world hits you right upside the face, and you start to get questions about insurance and cost, and you realize that your patients have lives that are involved around a lot of things. Going to the dentist is often low on the priority list for many people. So you can get desperate and lose your purpose trying to please too many people.

Don’t become a “we treat everybody” practice. That is a quick way to a stressful disaster with lots of loose ends and an overworked team and doctor.

For example, we encourage you to be insurance friendly, but not be insurance driven.

The first practice we purchased (back in 2010) was only seeing patients about two days a week. We implemented new services and some marketing because I wanted to be in the office four days a week.

After about a year we grew to five days a week. Then even some six day weeks until we added more providers and was able to ease back off some of the days I was seeing patients. In that process, we learned a lot about insurance patients, fees for service patients and how to approach each one. We learned that by developing membership plans we could better attract and retain the right patients for us and our Purpose. 

Keith Cunningham author of The Road Less Stupid, put it this way: “growth is what you say ‘yes’ to. Success is what you say ‘no’ to.”

Are you just trying to grow? Or are you working to be successful and profitable?

(And my biggest caution would be if you’re going to have a fee for service practice, don’t mix it with too many insurance driven systems because your patients will get a mixed message.)

We take the approach that we are insurance friendly, but not insurance driven. As of right now we do accept one insurance plan and that’s because we’ve negotiated a much lower write off and it has been an excellent source of quality new patients. Because get a higher reimbursement than average and we look at that write off as essentially a marketing expense to acquire new patients.

The dark side of accepting a plan is that you have to pay that “marketing” or acquisition cost every time you see the patients. That write off is much less than what it would be accepting with most insurance contracts, which we’ve chosen not to pursue. 

We’ve learned over the years that our membership patients are 5x to 8x more valuable than our cash patients or insured patients. Many of our patients even come to the office with insurance and they end up dropping it and going with our membership plan, especially if they’re looking for an individual type plan. These are often your patients who are retired or self-employed, or they’ve changed jobs.

And when you run these reports and your software, there are a couple that we suggest you run. One would be what your collections are based on. Insured versus non-insured patients. And then you can extract that data and compare it. And that’s how we’ve figured out. You know, that our membership patients are bringing five to eight times more to the table that might make it easier for you to drop some insurance plans that you’re not interested in.

Remember, it’s not the best use of your time or your team’s time to continually chase the lower and lower potential opportunities. So, hopefully this has been helpful. We look forward to your questions for the next video and we appreciate the feedback and insight.

If you’re interested in learning more, you can reach out to us by reaching us at the contact information below, and we look forward to seeing you next month.


Dr. Tyler Williams 

For just $7, you can download a really cool tool we’ve put together. It will allow you to attract as many patients as you want month after month using Facebook. And did I mention, no expensive ads?!?

To be frank, it will need a little “elbow grease,” to get the results you are looking for. These could be the patients that are going to help you and your team meet your annual goals for the rest of 2022 and beyond. 

If you’re interested, simple email us at and put “Qualified Referrals” in the subject line.

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