For decades, dental insurance has felt like a game where the referee works for the other team.

You submit the claim.
They “review” it.
They adjust it.
They reduce it.
They bundle it.
They delay it.

And somehow, the math never quite adds up.

But in 2026, the game changes.

Enter the 85% Rule, officially known as Dental Loss Ratio (DLR) legislation.

What Is the 85% Rule?

Dental Loss Ratio laws require insurance carriers to spend 80 to 85% of premium revenue on patient care and provider reimbursements, not executive bonuses, not bloated administrative overhead, not shareholder padding.

If they don’t meet that threshold?

They must issue rebates to patients.

In other words:
The scoreboard is finally visible.

For years, insurers operated in a financial black box. Now they have to show their work.

And when you show your work, the numbers tell a story.

Why This Is a Big Deal for Dentists

Let’s translate this into real world practice economics.

If an insurance company is required to spend 85% of premiums on care, and they’re currently underpaying providers…

They have two options:

1. Send rebate checks to patients.

2. Increase reimbursements to providers.

Which one do you think they’d rather do?

Exactly.

This creates leverage.

For years, practices were told:

“We can’t increase fees.”
“This is our standard schedule.”
“Market conditions don’t allow adjustments.”

But now?

If carriers don’t hit that payout threshold, they’re out of compliance.

That changes the negotiation table.

The Hidden Truth DLR Exposes

Here’s what DLR quietly proves:

If insurers suddenly can afford higher reimbursement rates to hit compliance targets…
Then they could have afforded them before.

The issue was never ability.

It was accountability.

Now accountability is written into law.

That’s not political theater. That’s math.

The Practices Who Win

The practices that benefit most from DLR are not the ones who sit back and wait.

They’re the ones who:

1. Review every PPO contract.

2. Analyze current reimbursement vs. market benchmarks.

3. Audit EOBs for underpayments.

4. Open negotiations strategically while carriers are under compliance pressure.

Because here’s the truth:

DLR doesn’t automatically increase your fees.

It creates the opportunity to increase your fees.

There’s a difference.

What This Means for Your Practice in 2026

If you haven’t reviewed your contracts in the last 12 to 18 months, you’re likely operating under pre DLR leverage assumptions.

That’s old math.

This is a new era.

The balance of power is shifting, slowly, state by state, as DLR standards roll out and enforcement tightens. Some states are adopting full 85% thresholds. Others are closer to 80%. Implementation timelines vary.

Which raises the real question:

How is your state handling DLR compliance?

Because where transparency increases, negotiation strength follows.

The Bottom Line

For years, insurance companies played “hide the ball.”

Now the ball is on the table.

The scoreboard is lit up.

And for the first time in a long time, practices have measurable leverage.

The power isn’t automatically back in your hands.

But it’s within reach.

The only question is:

Are you going to use it?

Benjamin Tuinei
Founder – Veritas Dental Resources, LLC
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com