Let’s play a quick word association game. I say antitrust, and you say…

• “Big pharma lawsuits”?

• “That tech company Congress keeps grilling”?

• “Something only lawyers care about”?

If “I have no idea what that means for my dental practice” crossed your mind, you’re not alone. But here’s the truth: understanding antitrust laws might be the most underused weapon dentists have against the insurance machine. And the American Dental Association (ADA) wants you to know it.

The ADA’s official Antitrust Compliance Handbook is an essential read. It lays out how dental professionals can avoid crossing legal lines—but it also subtly reveals what lines insurers must follow too.

Let’s unpack what this all means, how it protects you, and how it might be used to finally call out fee discrimination, gag clauses, and other suspect behavior from payers.

What Is Antitrust Law, Anyway?

Antitrust laws exist to protect competition, prevent price fixing, and prohibit monopolistic behavior. These rules make sure no group unfairly controls the market—whether it’s dentists or insurance giants.

For dentists, this mostly means:

• Don’t collude on prices or fee schedules.

• Don’t boycott insurance plans collectively.

• Don’t share sensitive business info like reimbursement rates with competitors.

The ADA emphasizes that even talking about your PPO-negotiated fees with another dentist can land you in legal hot water. Seems harsh? Maybe. But it’s meant to prevent artificial inflation or deflation of prices in any given market.

But guess what? Insurers are also bound by antitrust laws. And they’re not always as clean as they claim to be.

What Insurance Companies Don’t Want You to Know About Antitrust

While the ADA focuses heavily on what dentists can’t do, antitrust law also applies to payers. Here are key areas where they have to play fair—and where you can potentially push back:

Unfair Discrimination in Fee Schedules (a.k.a. Fee Favoritism)

If you discover that the same insurance plan is paying another dentist down the street significantly more for the exact same procedure, alarm bells should ring.

That’s not just annoying—it could be a violation of antitrust principles related to “restraint of trade.” If the payer cannot justify those differences with measurable, contract-based reasons (e.g., location, credentialing status, negotiated volume), it smells like anti-competitive behavior.

Tip: If a patient brings in an EOB or treatment plan from another office showing a much higher allowable, and you’re in-network with the same plan, document it. It may be legal leverage.

Gag Clauses and Market Manipulation

Some insurance plans include contract language that prohibits dentists from disclosing fee schedules to patients or even to third parties. These so-called "gag clauses" suppress price transparency, which violates the spirit (and potentially the letter) of federal antitrust laws.

Congress already acted on this. The 2021 Consolidated Appropriations Act included provisions that ban gag clauses between insurers and providers in both medical and dental contracts.

Tip: If your payer agreement still contains these clauses, challenge them. This isn't just about transparency—it's about protecting free-market principles.

Most-Favored-Nation Clauses (aka: "We Own You" Language)

Some insurance contracts historically included terms requiring dentists to offer the insurer the lowest fees they give anyone else. That’s called a Most-Favored-Nation (MFN) clause.

Courts and state lawmakers have taken action against MFN clauses in health and dental contracts because they suppress competition, a direct violation of antitrust standards.

Tip: Scrutinize your contracts for MFN-like language. You have a right to run your practice like a business—not a hostage negotiation.

So… How Can Knowing Antitrust Law Help Your Practice?

Here’s the good news: dentists don’t have to feel powerless. Understanding how antitrust law protects you can open the door to better business practices, better negotiations, and maybe even legal recourse.

1. Call Out Fee Discrimination With Confidence

Let’s say your patient gets a second opinion from another in-network provider, and the EOB reveals that you're getting paid $200 less for the same crown. That’s not hearsay—it’s evidence.

You didn’t “collude” or “share fees”—you’re simply using what a patient legally brought in.

Use it. Ask the plan to justify the disparity. Cite “restraint of trade” if appropriate. It might not spark an audit, but it puts pressure on the plan to re-evaluate your reimbursement.

2. Push Back on Contract Abuses

Gag clauses? Fee caps on non-covered services? MFN restrictions?

If they interfere with your ability to operate freely in the market, they may be unlawful under antitrust law. Let your payer know that you’re aware of the law. Consider reporting egregious contract provisions to the Federal Trade Commission (FTC) or your State Attorney General.

3. Stay Clean—and Smart—When Talking to Other Dentists

Yes, you should absolutely avoid sharing your negotiated fees. But there’s nothing illegal about comparing your insurance experience, trends, denials, and even which payers are more flexible in negotiations. Share general insights, not numbers.

You can be strategic—and compliant.

Where the ADA Fits In (and Why It Matters)

The ADA’s antitrust booklet is a guide to help dentists avoid legal risk—but also to build awareness. It emphasizes that the profession must stay above board in how it handles market data and relationships. But if you're dealing with insurance companies that don’t follow those same rules, you now have language and leverage to call them out.

The ADA doesn’t litigate on your behalf, but their policy booklet—and your own proactive understanding of antitrust law—can be the start of something powerful: A practice that runs profitably, ethically, and fearlessly.

Quick Recap: What Dentists Should Remember

• Never share negotiated fees with other providers. That’s antitrust 101.

• Insurance companies must also follow antitrust laws, especially regarding fair competition and transparency.

• Fee discrimination without justification could be a restraint of trade.

• Gag clauses and MFN provisions are now under legal scrutiny—don’t tolerate them.

• Use patient-provided EOBs and treatment plans as legal leverage when questioning insurance pay structures.

• Stay informed. When you understand the rules, you can better enforce your rights.

Final Word: Knowledge is Leverage. Leverage is Power.

Dentists often feel like David standing in front of the insurance industry's Goliath. But David had one thing going for him—he knew exactly where to aim.

So next time you hear “antitrust,” don’t tune out. Tune in. Because buried in that legal jargon is a blueprint for reclaiming control over your business, your income, and your ability to practice without fear.

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