"Do you take my insurance?" opens most new-patient calls, and more practices are answering no. In the ADA Health Policy Institute's survey for the fourth quarter of 2025, about 29% of the 704 dentists polled had dropped at least one insurance network during the year, and the networks they left had covered almost a quarter of their patients. Most front desks, and most answering services, deliver the no as "we don't take that," and the caller dials the next practice. Here is what out-of-network actually means for the patient, the one rule for saying no, and a script for each version of the question.
What the caller doesn't know
The caller hears "we don't take your insurance" as "you can't afford us." Usually that isn't true. Three facts change the answer:
- PPO and HMO plans behave differently. Delta Dental's explainer says a dental HMO "does not cover costs for out-of-network dental care," while under a PPO, "depending on the plan, you may receive partial reimbursement for treatment by an out-of-network dentist." So ask which kind the caller has.
- Out of network means paying more, not paying everything. Delta Dental of Michigan's member flyer walks through an $1,100 crown: the plan sets a non-participating fee of $754, pays 50% of it, $377, and the patient owes $723, including a $346 balance bill. The patient still got $377 from a plan the dentist "doesn't take." The flyer also notes the member "may need to file own claims," so "we'll file it for you" is worth saying.
- A no needs a price next to it. If the plan won't pay, the next question is "then what does it cost?" A practice that can't answer in one breath has turned a no into a hang-up.
The one rule: never end on "no"
Every script below has three parts: name the plan, say what is true about it in one sentence, and offer the next step (a benefits check, a self-pay fee, or a membership plan). Then ask for the appointment. A receptionist, human or AI, that stops after part two has done the caller's comparison shopping for them.
Script 1: a PPO you're out of network with
"We're not in network with [plan], but most PPO plans still pay part of the cost when you see an out-of-network dentist; you'd cover the difference. We file the claim for you, and before your first visit our team checks your exact benefits so you know the figure. The new-patient exam and x-rays are $[fee]. Would [day] or [day] work?"
Only promise courtesy filing if you do it. Then collect the plan name and member ID so the benefits check happens before the appointment, not in the chair.
Script 2: a DHMO or a plan you can't work with
This is the honest no. HMO plans don't pay out of network, so the only useful thing to offer is a price and an alternative.
"That plan only covers dentists on its own list, and we're not on it, so it wouldn't pay toward a visit here. What we can offer is our membership plan: $[amount] a year covers two cleanings, exams and x-rays, and takes [X]% off other treatment. Or you can pay as you go; a new-patient exam with x-rays is $[fee]. Shall I book the exam and send you the plan details?"
No membership plan yet? In an ADA Health Policy Institute poll of 874 owner dentists in July 2023, 26% offered an in-office plan and 22% were considering one: a fixed yearly fee, preventive care included, a discount on the rest, with state rules to check first. Our orthodontic scripts cover lifetime orthodontic maximums separately.
Script 3: "I don't have insurance. What does it cost?"
"No problem. A new-patient exam with x-rays is $[fee], and a cleaning is $[fee]. If the dentist recommends anything else, you'll get a written estimate before we do it, so there are no surprises. We also have a membership plan that brings the yearly cost down. Shall I find you a time this week?"
The written-estimate line is more than reassurance. In February 2023 CMS confirmed to the ADA that dental providers must give uninsured and self-pay patients a good faith estimate under the No Surprises Act, and a patient can dispute a bill that lands at least $400 above it. Say it on the phone; it is a selling point as much as a requirement.
Script 4, med spa: "Does insurance cover Botox? Can I use my HSA?"
Med spas get the same question in a different costume, and the honest answer is no for almost the whole menu. IRS Publication 502 says you generally can't include cosmetic surgery, "any procedure that is directed at improving the patient's appearance" that doesn't "meaningfully promote the proper function of the body"; the exception is correcting a deformity from a congenital abnormality, injury or disfiguring disease.
"Cosmetic treatments like Botox and filler aren't covered by health insurance, and HSA and FSA accounts generally can't be used for them either; your plan administrator makes that call, not us. Our Botox is $[price] per unit, most first-time foreheads use [range] units, and we offer [financing option]. The consult is [free / $X] and comes off your first treatment. Weekday evenings or Saturday?"
Never say a treatment "should be HSA-eligible," and never suggest coding a cosmetic visit as medical. Our med spa receptionist page shows the pricing half of this call.
Loading this into an answering service or AI
A live agent or an AI can deliver every script above, but only from three lists you maintain: plans you're in network with, by the names patients use; PPO plans you file for as a courtesy; and plans you can't work with, paired with the self-pay fee sheet and membership terms. Add two rules: no coverage percentages on the phone ("about 80%" is a guess until the benefits check), and "someone will call you back about insurance" is not an answer. Then test it: call your own line after hours and name a plan from each list, plus one on none of them. The right answer to the unknown plan is "I'll have our team check that and call you back today; what's the plan name?" followed by a booked exam. The after-hours call test has the method; the BAA guide covers the plan details it collects.
Hear what your patients would hear
ClinicEcho's AI receptionist is answering a demo dental practice right now. Call it, ask about an appointment, try to book. Then request a free audit and we'll call your own clinic after hours and show you what happens.
Frequently asked questions
Should we just say "yes, we take it" and sort it out later?
No. A caller who hears "yes" and then gets a balance bill writes the review you don't want. "We're out of network, your plan may still pay part, and we'll check before you come in" is one sentence longer and true.
How much should the front desk explain about balance billing?
One sentence: "Your plan pays its out-of-network share, you cover the rest, and we'll give you the figure before any treatment." The benefits check does the detail.
Can an AI receptionist answer insurance questions?
From the three lists you give it: in network, filed as a courtesy, and not accepted. It quotes your self-pay fees and membership plan, collects the plan name and member ID for your team to verify, and never guesses at coverage. ClinicEcho does this for $497 a month with a 14-day free trial, under a BAA signed before it takes a call.
What about Medicaid or CHIP callers if we don't participate?
Say so plainly, give your self-pay exam fee and membership option, and don't guess at what the program covers elsewhere.
Sources
- Becker's Dental Review, "29% of dentists dropped insurers in 2025: Report" (Jan 22, 2026), reporting ADA Health Policy Institute, Economic Outlook, Q4 2025 (704 dentists)
- Delta Dental, "Dental HMO vs. PPO dental insurance: what's the difference?"
- Delta Dental of Michigan, "Choosing a Dentist" member flyer ($1,100 crown example)
- ADA News, "ADA receives clarification on No Surprises Act" (Feb 28, 2023)
- Becker's Dental Review, "More than 25% of practices offer in-office dental plans" (Aug 1, 2023; ADA HPI poll)
- American Dental Association, "Is an in-office dental plan right for your practice?"
- IRS Publication 502 (2025), Medical and Dental Expenses (cosmetic surgery)