Once upon a time (okay, about 20 years ago), there was a dark and stormy cloud hanging over the healthcare landscape. Insurance companies — in all their boundless generosity (read: sarcasm) — were having a field day underpaying out-of-network claims and leaving patients (and dentists) holding the bag.
And not even a nice bag.
We're talking the kind you get at a gas station at 2 a.m. when you realize you forgot toothpaste.

This is the story of Fair Health: a little-known but critically important knight in shining armor who showed up, fought the good fight, and gave dentists (and patients) a weapon to battle insurance nonsense with facts, data, and receipts.

Let’s dig into the full history — with a side of humor, some battle cries, and a lot of reasons why you, as a dentist, should be cheering for Fair Health like it’s the underdog in a sports movie.

The Beginning: How Insurance Companies Got a Little Too Creative

Before 2009, when patients went "out of network" for healthcare (including dentistry), insurers would reimburse them based on "usual and customary rates" (UCR).
Sounds fair, right?

Well, brace yourself.
The "usual and customary rates" were calculated by… the insurance companies themselves.
(Insert collective eye-roll here.)

And surprise: they lowballed everything.
Imagine a patient getting a crown.
The dentist charges $1,400.
Insurance company says, “Hmm, based on our highly scientific and totally unbiased secret data, the UCR is actually $650. So, we’ll reimburse $400, and the patient can just, you know, figure out the rest.”

It was a rigged game, plain and simple.
And because patients thought insurance was being fair, they often blamed the doctors for "charging too much."
Dentists got the bad PR. Patients got stuck with bills. Insurance CEOs got their third yacht.

It was beautiful — for them.
Everyone else? Not so much.

The Tipping Point: Cue the Lawsuits

Eventually, people noticed. (It took long enough.)
In 2009, the New York Attorney General’s Office, led by Andrew Cuomo (yes, that Andrew Cuomo), launched a major investigation into the insurance industry's "UCR" practices.

Turns out — gasp! — insurance companies had been using a database called Ingenix to determine UCRs.
And guess who owned Ingenix?
UnitedHealth Group, one of the biggest insurance companies in the country.
So yes, the fox was literally guarding the henhouse.

The investigation concluded what we all suspected:

• The data was manipulated to consistently underpay out-of-network claims.

• Patients were being systematically ripped off.

• Doctors were being undermined and villainized for charging reasonable fees.

Outcome? Massive settlements totaling nearly $100 million.

• UnitedHealth had to pay $50 million to create a truly independent database.

• Other insurers (like Aetna, Cigna, and WellPoint) coughed up millions too.

And thus, in a beautiful, karmic twist of fate, Fair Health was born.

The Birth of Fair Health (Cue the Trumpets)

In 2009, with a pile of settlement money and a big mission, Fair Health launched as a nonprofit, independent organization with a crystal-clear goal:

Collect real data. Set real reimbursement benchmarks. Restore fairness.

Today, Fair Health houses the largest collection of privately billed healthcare claims data in the United States — over 41 billion claim records and counting.

They built:

• FH Consumer tools for patients to check prices.

• FH Benchmarks for insurers, government, and researchers.

• FH Charge Reimbursement Benchmarks that reflect what healthcare actually costs, not what insurance companies wish it cost.

In short: Fair Health introduced a level of transparency that insurance companies absolutely loathed but everyone else desperately needed.

Why Should Dentists Care? (Other Than the Obvious)

Dentists, listen up:
Fair Health is one of your best secret weapons.

Here’s how you can fully use it to your advantage:

1. Fight Lowball Insurance Payments

If an insurance company tries to stiff your patient (or you) on an out-of-network reimbursement, you now have actual market data to fight back.

• Use Fair Health to look up the regional UCR fee.

• Provide patients with proof that their insurer is underpaying.

• File appeals with Fair Health data attached — it’s like bringing a bazooka to a knife fight.

2. Educate Your Patients

Patients often assume their insurance is looking out for them (cute, right?).
By showing them Fair Health data, you can:

• Build trust.

• Shift blame where it belongs — onto the insurance company.

• Empower patients to fight for themselves, which takes pressure off you.

Imagine handing a frustrated patient a Fair Health printout and saying:
"Here’s what the independent data says you should be reimbursed. Let’s go get what you deserve."
Mic drop moment.

3. Optimize Your Fee Schedules

Fair Health benchmarks can help you ensure your own fees aren’t wildly out of sync with the market — without undercutting your value.
Smart dentists use this data to:

• Set strategic, defensible fee schedules.

• Stay competitive without racing to the bottom.

• Prepare evidence for PPO fee negotiations.

Fact: Insurance companies LOVE when dentists guess blindly.
Fair Health makes sure you never have to.

4. Strengthen PPO Negotiations

Planning to renegotiate your PPO fees? (And if not, why the heck not?)
Fair Health can serve as:

• A third-party validation of regional fee trends.

• Ammunition to ask for higher reimbursements.

• Evidence that your requests aren’t just random — they’re grounded in hard data.

PPO negotiations are basically high-stakes poker. Fair Health is your set of aces up the sleeve.

Will Fair Health Save Dentistry Alone?

No.
Fair Health is an incredible tool — but it’s still up to dentists to wield it like the mighty sword it is.

Insurance companies are masters at:

• Confusing patients.

• Dodging responsibility.

• Pretending everything is "reasonable."

Fair Health pokes massive holes in that narrative — but only if you use it, educate patients, and refuse to stay quiet.

The bigger our collective voice, the harder it is for insurance to keep playing their old tricks.

The Final Pep Talk

Dentists, you’re not powerless.
You have clinical excellence, patient trust, professional associations and now — third-party data to back you up.

Use it.

• Reference Fair Health in appeals.

• Teach patients to check their own reimbursements.

• Support legislation that forces more insurance transparency.

• Get involved with your dental associations and local lawmakers.

• Fight the good fight every single day.

Because here’s the truth:
Insurance companies aren’t going to change because they grow a conscience.
They’ll change because we force them to.

Fair Health handed us the torch.
Now it’s our job to light the path forward.

And trust me — the view from the front of the parade is a whole lot better than the view from the back of the insurance company’s yacht.

Quick Recap:

• Fair Health was born after massive lawsuits exposed insurance companies’ abuse of UCR data.

• Fair Health provides real, independent healthcare cost benchmarks.

• Dentists can use Fair Health to fight low reimbursements, educate patients, optimize fees, and strengthen PPO negotiations.

• The future of dentistry depends on dentists using these tools, educating the public, and standing tall.

Fair Health is your data-powered megaphone.
Now, let’s make some noise.

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