And What Dentists Can Do When Quality Care Feels Restricted by Insurance

If you’ve ever felt like your hands are tied when trying to provide quality care—because an insurance company won’t reimburse enough for even the basics—you’re not alone.

Across the country, dentists are asking the same question:
“When will insurance companies take reimbursements seriously?”

Reimbursement rates have stagnated (or declined), while the cost of doing business—materials, lab fees, payroll, rent—keeps rising. And all the while, insurance companies continue to report record profits.

So where does that leave you, the provider, trying to do right by your patients while running a business?

Let’s break down what’s really happening—and more importantly, what you can do about it.

The Harsh Truth: Insurance Plans Are Not Designed to Prioritize Quality Care

Dental insurance is not healthcare insurance. It’s a financial tool with capped benefits, designed more like a discount plan than true coverage.

Here’s what you’re up against:

• Annual maximums haven’t kept pace with inflation—many still sit at $1,000–$1,500, just as they did in the 1980s.

• Reimbursement rates often fall well below your UCR (usual, customary, and reasonable) fees.

• PPO participation can result in 30–50% write-offs—and in many cases, you lose money on some procedures.

Let’s be real: many PPO contracts make it nearly impossible to deliver comprehensive, modern care without taking a financial hit.

Why Insurance Plans Don’t “Take It Seriously”

It’s not that they’re unaware—they’re just not incentivized to care.

• They are businesses, and their goal is to reduce risk and maximize profits.

• They rely on network volume to keep premiums low for employers and limit claims payouts.

• As long as enough providers stay in-network, they have no pressure to raise fees.

So if you're waiting for insurance companies to suddenly increase reimbursements out of goodwill or fairness... you’ll be waiting a long time.

So What Can You Do?

You can't change the system overnight, but you can change how you participate in it. Here’s how:

1. Know Your Numbers—and Your Limits

Start by identifying:

• Your true overhead per procedure

• Your top write-offs by insurance plan

• Plans that generate high volume but low profit

Once you know which plans are bleeding your practice dry, you can begin to make data-driven decisions about which ones to renegotiate—or drop altogether.

2. Negotiate, Then Re-negotiate

PPO fees are negotiable. Many dentists don’t know this—or don’t try.

Gather your leverage:

• Zip code shortages

• Production volume

• Number of new patients you bring to the plan

• Unique services you provide

Then present a data-backed proposal for a fee increase. Even a 5–10% bump on your top 20 codes can make a massive difference over time.

(And if you don’t have time? There are negotiation services that specialize in this and can do it for you.)

3. Create a Strategy to Go Out-of-Network

You don’t need to go “insurance-free” overnight. But you can create a phased strategy to reduce your dependence on low-paying plans.

Start by:

• Identifying which plans you’d like to leave

• Building a script for your team to educate patients on your value and options

• Offering in-house membership plans for uninsured or out-of-network patients

• Communicating clearly that you still work with their insurance, even if you’re not in-network

Many patients will stay if they trust your care and understand your value.

4. Increase Case Acceptance Through Better Communication

The more patients say “yes” to comprehensive treatment, the less you rely on insurance for your income.

Train your team to:

• Focus on the benefits of care, not the limitations of coverage

• Use visual aids, intraoral photos, and emotional language to connect with patients

• Present financing options confidently

Your goal is to help patients prioritize their health over their benefits.

5. Advocate and Educate

Be the voice of reason for your patients. Help them understand:

• Dental insurance is a supplement, not full coverage

• Their benefits are designed to reduce cost—not guarantee care

• Sometimes the best treatment option is not the one insurance pays for

When patients hear this truth consistently, they become more open to investing in their care.

The Bottom Line

Insurance companies won’t start taking reimbursements seriously until enough providers push back. That means:

• Saying “no” to contracts that don’t make financial sense

• Building value-based relationships with your patients

• Creating alternatives that put you in control—not the plan

You became a dentist to change lives—not to chase claims and justify your worth to insurance reps.

The good news? You can build a profitable, fulfilling practice that prioritizes patient care—even in a broken insurance system. It starts with recognizing your value and choosing not to settle for less.

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