Let’s start with a tough pill to swallow:
If you own a dental practice and don’t understand how dental insurance works, you’re not running a business—you’re hoping one survives.

Look, we get it. You became a dentist to fix teeth, not to fight with insurance companies, decode cryptic EOBs, or explain to angry patients why their crown wasn’t covered “even though their last dentist said it would be.” But here’s the truth bomb:

Dental insurance is responsible for nearly 90% of your practice’s revenue.
Ignore it at your own financial peril.

Why Clinically Excellent Dentists Still Go Broke

You could be the next Kois, Spear, or Pankey—but if your front desk doesn't verify insurance correctly or submit claims properly, your brilliant crown preps won’t pay your rent. Dental insurance is not a side hustle in your practice. It is the hustle. It touches everything—scheduling, treatment acceptance, AR, and yes, your paycheck.

And let’s not sugarcoat this: Most front office teams don’t get the training they need to manage insurance like pros. It’s not their fault. Most dentists hire for personality, throw them into the deep end, and then hope for the best. That’s like handing a scalpel to someone and hoping they figure out how to do a flap surgery because they were great at answering phones.

As a business owner, if you don’t understand how the insurance engine powers your practice, you’re flying blind.

What Should You Actually Be Focusing On?

Let’s break this down like a pulp chamber—clean, concise, and (hopefully) not painful.

1. Know the Contractual Game You're In

Every PPO you sign with is a legal contract. That contract defines your:

• Fees (AKA your revenue ceiling)

• Timely filing limits (miss those and you donate your work)

• Coordination of benefits rules

• Downgrades and bundling policies (e.g., buildups magically vanishing)

• Re-credentialing deadlines

If you haven’t reviewed your PPO contracts in years, guess what? You might be the proud owner of a declining reimbursement schedule while your overhead has skyrocketed.

Pro Tip: Learn the difference between fee-for-service, PPO, and “PPO-pretending-to-be-FFS” models. You can’t manage what you don’t define.

2. Insurance-Related Key Performance Indicators (KPIs) You Should Be Watching Religiously

Like flossing, you may not love it—but it saves your financial life.

Here are the insurance KPIs every practice owner should be checking at least monthly:

Insurance Collection Percentage

Formula: Insurance Collections ÷ Insurance Net Production
Target: 98–100%
Low numbers mean your claims are being denied, underpaid, or written off unnecessarily.

Days in Insurance Accounts Receivable

Formula: Total Insurance AR ÷ Average Daily Insurance Production
Target: Less than 30 days
If insurance AR is aging like fine wine (60+ days), your team may be sitting on unpaid claims that could turn into write-offs.

Claim Aging Report

How many claims are over 30, 60, 90 days?
Target: <10% of total AR should be over 90 days
This report will tell you who’s following up... and who isn’t.

Denied Claims Percentage

Formula: Number of Denied Claims ÷ Total Claims Submitted
Target: Less than 5%
A high denial rate = bad submissions, poor documentation, or just playing in the wrong network.

Write-Off Rate by PPO

Formula: (UCR – PPO Fee) × Volume
Target: Strategically managed and negotiated
Tracking this shows you which PPOs are bleeding your margins and whether renegotiation (or dropping them) is needed.

Buildup Claim Approval Rate
Track how often you're being paid for buildups (D2950). If insurance is bundling them with crowns, your revenue is disappearing.

3. Your Insurance Team is Either Your Profit Center or Your Money Pit

Hire smart. Train smarter. You want someone with:

• Obsessive attention to detail (the kind of person who gets mad at crooked wall art)

• Strong follow-up habits (calls insurance reps like a bill collector with caffeine)

• Pattern recognition (remembers that Delta Dental denies build-ups if the crown seat date isn’t on the claim)

Give them a clear protocol and audit their work monthly. Insurance isn’t “set it and forget it.” It’s “set it, then check it 17 times.”

4. Don’t Be Afraid of PPO Negotiations—Be Afraid of Stagnation

Most dentists sign onto PPOs at startup and never renegotiate. Meanwhile, insurance quietly lowers reimbursements or “adjusts” policies, and suddenly you’re doing molar endo for $350 while paying your assistant $30/hour.

Negotiating your PPO fees (or hiring a professional firm to do it) can add hundreds of thousands—or millions—in revenue over a career. That’s not fluff. That’s math.

5. Patient Complaints? They're Mad at You... for Something Insurance Did

If you're not proactively educating your patients on how their benefits work, they will assume:

• You overcharged them

• You're hiding their benefits

• You messed up their insurance

Your team should be trained to say things like:

“Unfortunately, insurance sometimes denies even medically necessary procedures. Here’s how you can appeal the denial or file a complaint with the state insurance commissioner.”

This isn’t just PR—it’s protection. Because in the eyes of the patient, you are the insurance company. Scary, right?

Bottom Line: Embrace the Pain or Pay for It

As a dental practice owner, you can’t outsource your way out of knowing how dental insurance works. You can delegate the tasks, but you cannot delegate the responsibility. Your revenue cycle is either your greatest asset—or your biggest liability. And since dental insurance touches almost every dollar you earn, ignoring it is like ignoring a leak in your operatory that’s flooding your entire building.

So put down the composite for a second. Learn how to read an EOB. Understand your KPIs. Support your insurance coordinator with training. And start treating insurance like it’s your second (and very needy) business partner.

Because guess what?
It already is.

Quick Recap (For Those Who Skim While Eating Lunch Between Patients):

Dental insurance fuels up to 90% of your revenue—own it, don’t ignore it

Track insurance-specific KPIs monthly (collections %, denial rate, claim aging, etc.)

Hire and train insurance-savvy admin team members (and audit them regularly)

Don’t fear PPO fee negotiations—fear underpayment

Train your team to communicate clearly with patients about benefits and denials

Ignoring insurance systems can cost you millions over your career

Want help negotiating PPO fees or auditing your insurance KPIs? Visit www.veritasdentalresources.com—because your PFM crown shouldn’t cost you more than it pays.

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