The Resilience of Dentists Against Insurance Companies: A Modern Battle

The Saga of Erik the Red, written in the 13th century, recounts the journey of Norse Vikings as they ventured into the lands now known as North America. The Vikings, renowned for their warrior culture, left a profound historical impact between the 8th and 11th centuries. Their legends, intertwined with gods such as Odin, Freyja, and Thor, have endured through centuries, even influencing modern entertainment through Marvel and Disney adaptations. The Vikings have a unique place in history, admired for their bravery and tenacity.

When Norse explorers arrived in the Americas around the year 1000 AD, they encountered indigenous peoples who had long inhabited the land. Despite being equipped with advanced weaponry—iron armor, steel spears, and axes—the Vikings were ultimately repelled by Native American tribes wielding weapons made from natural materials such as wood and stone. The Vikings referred to these native groups as Skraeling, meaning "weakling," only to later realize they had underestimated the strength and resilience of the indigenous warriors. As The Saga of Erik the Red describes, the Vikings eventually recognized that although the land was rich and promising, it would always be a battleground where they would live in a state of constant conflict and fear. This realization serves as an unintended tribute to the fortitude of the Native American tribes who successfully defended their territory.

In many ways, this historical struggle mirrors the current battle between dentists and the insurance industry. While both sides share a connection within the broader healthcare system, the financial dynamics are heavily skewed in favor of insurance companies. Over time, insurance providers have been granted more influence than many realize—controlling reimbursement rates and dictating the extent of benefits available to patients. Dentists have often been led to believe that participating in insurance networks constitutes a true partnership. However, experience has shown that these agreements are largely one-sided, leaving dentists with minimal control over fees and patient benefits. The evidence from both history and present-day interactions suggests that the dental profession has been strategically positioned in a disadvantageous relationship with insurers.

However, if there is one certainty about dentists, it is that they are neither weak nor directionless. They are determined, skilled professionals who are passionate about delivering high-quality care. Despite the persistent challenges posed by insurance companies, dentists are pushing back against an industry that often seeks to limit their autonomy. Below are some of the strategies that dentists are employing to regain control in the current insurance landscape.

Withdrawing from Insurance Networks

One of the most notable trends in dentistry today is the increasing number of providers opting out of insurance participation. Many dentists have grown frustrated with stagnant reimbursement rates that fail to keep pace with inflation and the rising costs of running a practice. In response to this exodus, some insurance companies have made attempts to retain network providers by offering modest fee increases. However, these adjustments often fall short of addressing the financial realities faced by dental professionals post-pandemic.

The departure of numerous dentists from insurance networks has highlighted an important truth: insurance carriers need dentists more than dentists need carriers. The ongoing loss of in-network providers has pressured insurers to make changes, but the response has largely been insufficient. As a result, many dentists continue to sever ties with restrictive insurance plans. This trend is not isolated to a single insurer—major carriers across the industry are witnessing a decline in participating providers. As this movement gains momentum, it is expected that further adjustments will be made to both benefits and reimbursement structures in an effort to retain network participation.

Fee Negotiation

In recent years, there has been a significant increase in the number of dentists actively negotiating their reimbursement rates. Data indicates that approximately 32% of in-network dentists engage in fee negotiations with insurers every two to five years. Of those dentists, 95% have, at some point, dropped an insurance plan due to a refusal to negotiate. Interestingly, when a dentist initiates contract termination, insurance companies attempt to renegotiate fees nearly 90% of the time in an effort to retain the provider.

Historically, insurance companies have offered fee increases ranging between 5% and 16% when pressured to negotiate. However, these adjustments still fall well below the customary fees charged by dentists, often lagging by 30% to 40%. Consequently, many dentists opt to proceed with contract termination unless they receive more competitive reimbursement rates.

According to Rick Wilford, CPA, the average patient retention rate for dentists transitioning out of major insurance networks is an impressive 81%. This statistic has emboldened more providers to approach negotiations with an out-of-network mindset. In other words, many dentists are prepared to leave insurance networks unless they receive sustainable fee adjustments. The fear of losing providers has led some insurers to break traditional norms, offering unprecedented rate increases—some as high as 70% above historical reimbursement levels. This shift signifies a growing realization within the insurance industry that dentists are no longer willing to accept unfavorable terms.

Challenging Denied Claims

Another critical area where dentists are fighting back against insurers is in the claims approval process. Insurance companies frequently employ tactics to delay payments, deny claims, or minimize reimbursement amounts. However, industry leaders like Tessina Bullock, president of Verus Dental, have demonstrated effective ways to counter these practices. Bullock has successfully engaged with local insurance commissioners to advocate on behalf of dentists and their patients, leveraging governmental oversight to hold insurers accountable.

Through these efforts, it has become evident that insurance companies are less likely to engage in unethical claims-processing behaviors when government regulators are involved. Dentists who actively challenge denied claims and report unfair practices to state insurance departments often see increased claim approvals and fewer payment delays. By utilizing regulatory support and appealing unjust denials, dentists can exert pressure on insurers to act more ethically in their reimbursements and benefit determinations.

The Future of Dentistry Without Insurance Constraints

The modern dental industry is undergoing a shift in how it interacts with insurance providers. The days of unquestioned compliance with insurer demands are fading as more dentists recognize their power to push back. Whether through exiting insurance networks, negotiating better fees, or challenging unfair claim denials, dental professionals are increasingly taking control of their financial stability and patient care autonomy.

Much like the Vikings who misjudged the strength of their Native American counterparts, insurance companies may soon realize they have underestimated the resilience of dentists. The battle is far from over, but with growing advocacy and strategic action, dentists are proving that they are not merely passive participants in a flawed system. Instead, they are emerging as strong, resourceful professionals who refuse to let insurance companies dictate the future of their practices.

Stay informed, stay engaged, and continue to fight for the profession and the patients you serve.