Saturday, Nov 1, 2025

How Dentists Can Finally Get the Upper Hand on Insurance (Yes… It’s Possible)

By Benjamin Tuinei

If you’ve ever felt like dealing with dental insurance is similar to trying to teach a cat to fetch, congratulations—you are officially a practice owner. You hold out the treat, you try to explain the rules, you show your enthusiasm… and the cat still walks off like you’re the unreasonable one in this relationship.

But here’s the thing: you don’t have to keep chasing the cat.
You can structure your practice in a way where insurance companies stop dictating your financial destiny.

After two decades of helping practices navigate the maze of PPO contracts, let me share the two most powerful moves you can make to position your practice for long-term success.

1. Negotiate Your PPO Fees (Your Future Self Will Thank You)

Many dentists still assume that a PPO fee schedule is a sacred document—like it was discovered in a cave somewhere next to ancient scriptures and must not be questioned.

Let me assure you:
Insurance companies update these fees with the same level of care most people use when updating the warranty information on their blender.

The reality?
You can negotiate your PPO fees.
Most dentists just don’t know it’s possible—or assume they aren’t important enough to merit an increase.

But here’s why negotiations work:

• Insurance networks are losing providers nationwide
• Replacing a dentist costs them far more than increasing your fees
• Leasing arrangements between networks give you leverage (if you know how to use them)
• Some networks would rather adjust your fees quietly than risk losing you

Negotiation isn’t magic—it’s strategy.
It’s understanding umbrella networks, overlap structures, and how to avoid accepting 1987-level reimbursements because a sub-network quietly signed you up without sending a fruit basket.

A well-negotiated PPO structure means:

More margin.
More options.
More control.

And fewer moments where your team asks, “Wait… how did THAT fee get in here?”

2. Develop an Out-of-Network Strategy (Freedom… With a Plan)

The second recommendation is simple:
Every practice should at least evaluate an out-of-network transition.

Notice I didn’t say jump off the PPO cliff with no parachute. I said evaluate.

Going out of network—when done properly—can transform a practice. It gives you the ability to:

• Set fair, sustainable fees
• Reduce dependence on plan approvals
• Spend more time with patients instead of paperwork
• Remove yourself from the “here’s what insurance will allow” handcuffs

The key is planning, communication, and timing.
You want a strategy—not a rebellion.

And the best part?

When more dentists step out of restrictive PPO plans, something fascinating happens:
Insurance companies suddenly discover room in the budget… and fee schedules mysteriously improve.

Imagine that.

Going out of network doesn't just help you—it helps the entire profession push reimbursement rates in the right direction.

The Bottom Line

If dentists want to thrive—not just survive—there are two paths:

Negotiate better.
Or liberate.

Preferably both.

The era of passively accepting whatever a PPO hands you is over.
This is your practice, your livelihood, and your opportunity to create a healthier financial model.

Insurance companies may still behave like the unpredictable cat…
but it’s time for dentists to stop being the ones stuck holding the treat.