Imagine this: You’ve completed the paperwork, jumped through the credentialing hoops, faxed (yes, faxed—because it's still 1998 in the insurance world) your NPI number, license, and CV to a medical insurance plan.

And then boom—you get the dreaded email.

“We’re sorry, but dentists do not qualify for credentialing under our medical provider network.”

Oh really? That’s cute. Because guess what? Federal law disagrees.

If you’ve ever been denied credentialing with medical insurance for being “just a dentist,” this article is your official toolkit to fight back—with logic, law, and a sprinkle of sass.

Let’s dive in, shall we?

“Dentists Aren’t Medical Providers” – Said No Law Ever

The idea that dentists can't bill medical insurance is not just incorrect—it’s legally wrong. While not all dental procedures qualify as medically necessary (sorry, cosmetic veneers), many absolutely do:

• Biopsies

• Sleep apnea appliances

• Oral surgery

• TMD therapy

• Trauma repair

• Infections requiring medical intervention

So why the denial?

Simple. Insurance companies love gatekeeping. And if they can create confusion and delay your credentialing, guess who keeps the premiums and skips the payouts?

Federal Law: The Real MVP

Let’s talk law. And not the “Grey’s Anatomy” kind. The real law.

42 U.S. Code § 300gg–5 (a.k.a. Non-Discrimination in Health Care)

This gem is part of the Patient Protection and Affordable Care Act (ACA) and clearly states:

“A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law.”

Translation:
If you’re licensed to perform a medical service in your state, and it’s a benefit covered by the patient’s plan, they can’t deny you solely based on your provider type.

So unless you’re applying to be a cardiologist while holding a dental hygiene license (please don’t), you’re protected.

Bonus Statute for Flair:

Section 2706(a) of the Public Health Service Act—commonly cited in credentialing disputes—reinforces that insurance plans must allow any licensed provider to participate in-network if they’re offering covered services within their scope.

What About State Law?

Every state governs licensing scope differently, but in most cases:

• Oral surgeons are legally allowed to perform covered surgeries.

• General dentists can manage infections, prescribe medications, and deliver TMD or sleep apnea care.

• States like Texas, California, and New York have detailed dental practice acts that define where dental and medical care intersect.

Bottom line? If your state license allows you to perform a service covered under medical, the plan must allow credentialing for those services.

So What Do You Do When They Say No?

Step 1: Educate Them—Nicely

Respond with a letter that includes:

• A citation of 42 U.S. Code § 300gg–5

• A brief outline of your state license scope

• A polite-but-firm tone (resist the urge to include an eye-roll emoji)

“According to federal non-discrimination law under 42 USC § 300gg–5, I am entitled to participate in-network for medical services I am licensed to perform under state law. Please reconsider my application based on this legal precedent.”

Step 2: File a Formal Appeal

Use the insurer’s formal dispute resolution or credentialing appeal process. Attach:

• Your rejection letter

• The federal statute

• A list of services you perform that are covered under the patient’s medical plan

Step 3: Bring in Reinforcements

Don’t waste 40 hours arguing with a credentialing rep who once spilled coffee on your application.

Let the pros handle it.

VeritasDentalResources.com specializes in helping dentists with:

• Medical billing recommendations 

• Insurance training & appeals (Dental only)

• Navigating PPO negotiations (Dental only, for now)
  They’ve seen it all—and they speak fluent insurance. (They also don’t mind quoting legal codes to stubborn reps.)

Real Talk: Why Is This Even a Thing?

Medical insurance plans still act like dentists are stuck in the 1800s—yanking teeth under a tree with whiskey and pliers. Meanwhile, you’re performing soft tissue biopsies with a CO2 laser and placing sleep apnea appliances that literally save lives.

But sure, you’re just a dentist.

Let’s be honest: Medical insurers aren’t questioning your credentials because you’re unqualified. They’re just hoping you’ll go away.

Let’s not.

Key Takeaways (So You Can Bookmark This and Get Back to Dentistry):

• You have a legal right to credential with medical plans if you’re providing covered services under your license.

• Federal law (ACA, 42 USC § 300gg–5) prohibits discrimination based on provider type.

• State law defines your scope—review your state dental practice act.

• Document everything. Be firm, professional, and patient.

• When in doubt, call in the experts at Veritas Dental Resources to help you win the battle.

Final Word: You Belong Here

Dentistry is not the red-headed stepchild of healthcare.
You are treating disease, relieving pain, diagnosing pathology, and helping patients breathe, sleep, and eat better.

And you deserve to be paid for that work—through medical insurance, too.

So the next time a plan says, “Sorry, we don’t credential dentists,” feel free to respond with:

“Sorry, I don’t credential baseless discrimination. See you in the appeals process.”

Now go win your case. And maybe floss after. Just for good measure.

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