Working With Dental Insurance Companies: Tips for Dental Teams

Working with dental insurance companies can be a challenge, as most dentists know all too well. Getting reimbursed in a timely manner is not always the norm, a reality confirmed by the American Dental Association, which found that 19.9% of surveyed dentists have dropped some insurance networks. Just over 32.1% of dentists anticipate doing the same in 2025.¹

While patients may use various payment methods for dental care, it’s important for your dental practice to maintain a strong, collaborative relationship with dental insurance companies. This can help support smoother reimbursement on your end and serve to streamline the insurance process for patients.²

Understand Dental Insurance Trends

Dental trends can influence dental credentialing, dental insurance reimbursement rates and innovative treatments. Here are some of the trends that are changing when it comes to dental insurance:

• Terminology shift. Many patients refer to their dental coverage as “insurance,” but it’s more accurately described as a “benefit plan” that covers only certain costs. Understanding this terminology difference can help manage expectations around the dental payment experience.³
• Frequency limits. Some insurers are raising the frequency limitation on tooth fillings from two years to five years to decrease their liability. This creates dental insurance questions for dentists about the standard warranty period, who is responsible for fees (dentist or patient) and how patient oral hygiene behavior affects restorative efforts.³
• Payment for out-of-network claims. Changes in how fees are determined are affecting out-of-network claims. This can lead to reduced reimbursements for providers not in network and leave patients expecting coverage, only to be caught off guard by an unexpected balance.³
• Dental loss ratio. Since 2023, 25 states have filed dental loss ratio bills with their legislature proposing better insurance coverage for patients. The bills vary from state to state, with some pushing to increase the amount of insurance premiums spent on patient care vs. operating costs and others requiring dental insurers to notify individuals and groups when they are entitled to a refund on their premiums. Collectively, these proposals aim to provide transparency about where dental insurance benefits are going.⁴

Overcome Dental Insurance Challenges

When your dental practice faces challenges with patient coverage or insurance reimbursement rates, it can be tempting to attribute these difficulties to the insurance payers, but there are ways to make dental insurance work for you and your patients. The matters below are common, but they can be overcome with patience and conscientious effort.

• Denied claims. When a claim is denied, your dental practice will not be reimbursed for the services provided to a patient — but this decision can be appealed. Providing more information can potentially overturn the denial and lead to reimbursement. Pursuing the appeal is worth the effort because, ultimately, a denied claim means you’ll need to charge the patient the entire fee.²
• Disallowed claims. If the dental insurance company identifies a claim as disallowed, they will not reimburse the claim and will state that the patient is not responsible for payment either. This practice is generally discouraged by many leading organizations in the dental field as it can leave providers uncompensated for services rendered. In some cases, sending additional documentation or clarifying details to the insurance company can potentially help overturn the disallowance.²
• Lengthy processes. From contract approvals to dental reimbursements, any interaction with an insurance company can be lengthy. Patience and mutual respect are necessary to start off on the right foot. Remember that insurers have multiple providers to manage and time-consuming tasks to address, including yours. Being clear and concise can make their work easier.⁵

Improve Dental Insurance Company Interactions

Sometimes it’s necessary to call a dental insurance company for clarification, and sometimes it’s better to let a matter play out on its own.² Consider some of the following ways to align with an insurance company, and when it benefits you and your patients to establish helpful interactions.

• Master credentialing and contracts. Working with dental insurance companies to become an approved provider requires a complex dental insurance credentialing process and, once credentialed, a contract negotiation. The negotiation sets dental reimbursement rates for each procedure performed. Many dentists hire a lawyer or consultant for support.⁵
• Understand authorizations. “Preauthorization” and “predetermination” are separate and not interchangeable terms regarding potential benefits for a specific patient; the processes are outlined in state statutes. “Pre-approved” is not typically a term used by payers.⁶
• Consider umbrella plans. Contracting directly with every insurance company results in lower dental reimbursement fees, but insurance contracting with umbrella companies that negotiate higher reimbursement fees can help increase your dental fee schedule and improve profitability.²
• Train staff. Familiarize staff members with the insurance plans your office accepts, those you are in-network with and other payment methods, as well as submitting adequate documentation. Training in coding, insurance regulations and how to engage with insurance reps is also important. Make sure staff speak positively about insurance, recognizing any coverage the patient may have (even if minimal) to encourage patients to proceed with treatment.
• Build relationships. Take time to establish and build relationships with appropriate contacts at insurance companies. Open communication makes it easier to ask dental insurance questions, get answers and collaborate to help patients. Cultivate an environment of “we” instead of “us vs. them” with peer-to-peer reviews or calls, which focus on positive interactions rather than disagreements.
• Improve communication. Help your staff understand that there are circumstances when reaching out to the insurance company may not be the most efficient or effective approach. Overpayment, legal questions and contract matters, for instance, are sometimes better left to your own research (e.g., reviewing your insurance contract, consulting state laws or other reliable sources) to make sure you get fair compensation for the services you’ve provided.²
• Ensure accurate billing and coding. Accuracy is paramount when it comes to dental insurance claims and the billing process. Ensure all paperwork is complete and error-free to avoid denials or the need for resubmission. Take the time to get the dental coding right the first time — it’s easy to make errors with the existence of plentiful alphanumeric combinations for similar treatments.²
• Focus on the details. Claims processing delays occur for many reasons, such as X-rays not received or acknowledged by the insurance company. A lack of standardization from payers can lead to dental offices submitting additional attachments and requests to avoid delays, but the payers themselves are inundated by claims and accompanying materials, which do not help create an efficient system. It's important to notice the submission rules for each individual payer.⁷
• Review and analyze. Examine explanations of benefits for any errors, review insurance contracts regularly and carefully, understand contract terms and keep up to date with your state’s laws and regulations regarding dental insurance issues.

Dental Insurance Can Support a Smoother Patient Experience

Costs impact the consumer journey when it comes to dental care. Dental practices that accept insurance influence where a patient chooses to go for care. Collaborating with dental insurance companies can lead to more efficient reimbursement processes and help your patients feel supported throughout their care experience. When your practice and insurers work together, the result is a more streamlined practice, happier patients and effective use of both dental insurance and financing options.

A Dental Patient Financing Solution for Your Practice

Want to help more patients move forward with the dental care they want or need? Consider offering the CareCredit credit card as a financing solution. CareCredit allows patients to pay for out-of-pocket dental care costs over time while helping enhance the payments process for your practice.

When you accept CareCredit, patients can see if they prequalify with no impact to their credit score, and those who apply, if approved, can take advantage of special financing on qualifying purchases.* Additionally, you will be paid directly within two business days.

Learn more about the CareCredit credit card as a dental patient financing solution or start the provider enrollment process by filling out this form.

Author Bio

Elizabeth Weiss is a freelance writer and editor with more than 20 years of experience in content development for dentistry, orthodontics and cosmetic dermatology. She focuses on making healthcare topics accessible to readers and contributes to many fields, from family and estate law to industrial services and landscape design.

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