Choosing which dental insurance plans to be in-network with is one of the most important business decisions you’ll make as a dentist or specialist. The right partnerships can bring a steady flow of new patients and support your financial goals. The wrong ones can lead to low reimbursement rates, administrative headaches, and burnout.
With hundreds of plans on the market, and some reducing reimbursements year after year, it’s more important than ever to choose wisely.
This step-by-step guide walks you through what to look for in a dental insurance plan before joining its network and explains how to avoid common pitfalls.
Step 1: Evaluate Reimbursement Rates
Not all PPOs pay the same. Some dental plans offer higher reimbursements for the exact same procedure codes. Before signing any agreement, request a fee schedule and compare it to:
- Your current UCR (usual, customary, and reasonable) fees
- Local averages in your area
- The overhead cost for each procedure
Red flag: If the plan’s reimbursement rate is lower than your cost to deliver care, you’re losing money from day one.
Step 2: Understand the Administrative Burden
Before joining a plan, find out what kind of administrative workload it requires:
- Are pre-authorizations frequently required for common procedures and if so, what clinical documentation is needed?
- How often are claims denied or downgraded?
- Does the plan offer a provider portal to streamline tasks?
- Is support responsive when issues arise?
Plans that are difficult to work with can waste valuable time and reduce profitability, even if the fee schedule looks good on paper.
Step 3: Ask About Timely Payment and Claims Handling
Getting paid on time matters. Review the plan’s average:
- Claims processing turnaround time
- Payment schedule (weekly, bi-weekly, monthly?)
- Denial and appeal rate trends
Pro tip: Join forums or ask colleagues what their experience has been. Delays in payment are one of the most common complaints among dentists.
Step 4: Assess the Strength and Visibility of the Network
You want to work with plans that make it easy for new patients to find you. Ask:
- How many members are in the plan locally?
- Do any large employers in the area offer the plan to their employees?
- Does the plan rank well on DenScore’s “best dental insurance” listings or other comparison sites?
- Does the plan do anything to help you attract new patients to your practice?
A plan with a small or poorly managed network may not bring you enough patient volume to justify the discounted fees.
Step 5: Consider Contract Flexibility and Termination Clauses
Before signing, review:
- How often the insurer can change your fees without consent
- Whether there’s a contract renewal clause
- How much notice is required to leave the network
You want flexibility and clarity. Some plans reduce fees mid-contract or make it hard to exit, leaving you stuck with poor terms.
Bonus: Know Your Practice Goals
Not every insurance plan fits every practice. A fee-for-service boutique office may not benefit from a high-volume PPO model. Meanwhile, a general practice in a competitive urban area might see value in one or two PPO contracts with strong brand recognition.
Ask yourself:
- Do I want volume, or am I focused on profit per patient?
- Am I looking to grow quickly, or stabilize a current patient base?
- What services do I want to emphasize, and are those services well reimbursed by the plan?
Want Help Matching With the Right Dental Insurance Plan?
Choosing the best dental insurance plans to join doesn’t have to be overwhelming. At DenScore, we help dentists like you:
- Analyze plan options in your area
- Compare reimbursement data
- Avoid plans with high denial rates
Contact us and we’ll send you a form to fill out so we can match your practice with the dental insurance plan that delivers the most value to you and your patients.
Final Thoughts
In today’s dental economy, being selective about your PPO participation can protect your bottom line and reduce burnout. Use the steps above to vet each plan carefully, and don’t be afraid to say no to plans that don’t align with your values or financial reality.
