Here’s What You Need to Know About Insurance, Fees, and Credentialing

Congratulations! Buying your first dental practice straight out of dental school is a bold and exciting move. You’re stepping into ownership early—and that comes with freedom, opportunity, and yes, a steep learning curve.

While clinical skills are your foundation, owning a practice also means managing business systems, including how you work with dental insurance, set your fees, and get credentialed. Done right, these decisions can set your practice up for long-term success.

Here’s what you need to know to avoid pitfalls and make smart, strategic choices as a first-time owner.

1. Insurance: Choose Your Participation Wisely

You don’t have to (and shouldn’t) sign up for every PPO under the sun. Many new owners feel pressure to join all the plans because they’re worried about getting patients in the door. But not all insurance plans are created equal, and some can significantly hurt your bottom line.

What to Do:

• Request each PPO’s fee schedule before signing any contracts.

• Compare their fees to your cost of doing business—some reimburse less than your overhead.

• Ask: Will this plan send enough patients to justify the discount?

Pro Tip: Some PPOs lease their networks to others—this can mean you're participating in more plans than you realize. Be careful of "silent PPOs."

2. Set (and Understand) Your Office Fees Early

Even if you’re contracted with PPOs, you’ll still bill your UCR (usual, customary, and reasonable) fees. These are your full, undiscounted office fees—and they matter more than you think.

Insurance companies use your UCR fees to:

• Determine your write-offs,

• Analyze claims,

• And sometimes cap what you're allowed to charge out of network.

What to Do:

• Use national or regional benchmarks (like ADA, Henry Schein, or Dental Intel data) to set your UCR fees.

• Do not base your office fees on insurance fee schedules—they should reflect the true value of your services.

• Review and update your fee schedule annually.

Remember: Your UCR fees are the foundation of your financial strategy. Set them with intention, not guesswork.

3. Credentialing: Start Early, and Get Organized

Credentialing is the process of getting approved as a provider with insurance companies. It can take 60–120 days, and if you delay, you won’t get paid for the work you’re doing—even if you're seeing patients.

What to Do:

• Begin the credentialing process as soon as you’ve signed a purchase agreement for the practice.

• Make a list of all PPOs the selling doctor is in-network with.

• Decide which plans you’ll keep, drop, or renegotiate.

• Submit all necessary documents: dental license, malpractice insurance, DEA certificate, CV, etc.

Many insurance plans won’t backdate credentialing past the approval date—so every day you wait is potential lost revenue.

Bonus: Additional Smart Moves for First-Time Buyers

Communicate Insurance Participation with Clarity

Patients care how you handle their insurance. Whether you're in-network or out-of-network, train your front desk to:

• Explain benefits clearly,

• Submit claims on patients’ behalf,

• And position your value—not just your network status.

Know That Cash Flow > Production

You might be producing $100K/month, but if you’re writing off 40–50% due to low-paying PPOs, you’re spinning your wheels. Track your:

• Net collections,

• Adjustments/write-offs,

• And profitability per plan.

Consider Renegotiating PPO Fees After You’re Established

Once you're credentialed and have 6–12 months of production data, you can start renegotiating fee schedules. Focus on:

• Your top 20 procedure codes,

• Plans with high volume and low reimbursement,

• And plans you're willing to walk away from.

Final Thoughts: Build Smart from Day One

Owning a dental practice right after graduation is ambitious—and totally doable with the right guidance. Take time now to understand the business side of dentistry, especially your relationship with insurance, fee setting, and credentialing.

Your clinical skills will serve patients. Your business strategy will sustain your career.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com