Dental insurance has been both a “blessing and a curse” for dentistry. In the early years, reimbursements represented a much higher percentage of the customary fee, and patients were generally happy to make their co-payments. Today, insurance has become an increasingly complicated aspect of dentistry, adding complexity to the dental office experience for both patients and the team. But is this complexity warranted?
Understanding dental insurance
Dr. Roger P. Levin.
Let's start at the beginning. When dental insurance was first introduced, most practices didn't participate. In those days, practice success was largely automatic. Practices attracted a sufficient number of new patients to generate strong production and income, and insurance reimbursements covered a substantial portion of treatment.
Fast-forward to 2026, and the story is quite different. Dental insurance reimbursement rates have not kept pace with inflation or rising practice expenses and, in many cases, are declining.
We know this from speaking with hundreds of dentists and practice leaders, surveying dentists at seminars, and analyzing industry data. The Levin Group Dental Economics Practice Survey also shows that 50.5% of dentists report having at least one insurance plan with lower reimbursements in 2025.
Levin Group suggests that every practice conduct an annual insurance analysis that, at a minimum, includes:
- Total revenue from all insurance plans versus total practice revenue
- Percentage of total practice revenue generated by insurance plans
- Total revenue from each insurance plan in which the practice participates
- Percentage of total practice revenue represented by each insurance plan
- Percentage of insurance revenue represented by each insurance plan
- Number of patients covered by each participating insurance plan
- Percentage of all patients enrolled in participating insurance plans
- Percentage of new patients coming from participating insurance plans
- Percentage of new patients from insurance plans versus all new patients
- Total discounts associated with all insurance plans
- Total discounts by individual insurance plan
- Percentage discount for each insurance plan
This information provides an enormous amount of actionable data. For example, if an extremely high percentage of new patients comes from insurance plans, it is reasonable to assume that, over time, most patients in the practice will come from those plans.
If a practice has 80% of its patients enrolled in dental insurance plans, it can also assume that a sizable portion of its production will be discounted below its usual and customary fees.
This type of analysis should be performed regularly because it provides a clearer understanding of the practice's financial picture and helps determine whether the current business model and emerging trends are acceptable. Unfortunately, many practices feel trapped because they cannot simply leave insurance plans with excessive discounts and quickly replace those patients -- if they can replace them at all.
For example, we recently spoke with a frustrated practice leader who wanted to leave every insurance plan after a negative experience with an insurance company. After discussing the situation, we analyzed the practice's insurance mix and found that 35% of its revenue came from dental insurance.
Based on our experience, when a practice exits a dental insurance plan, at least half -- and often more -- of those patients leave the practice. If this dentist had followed through with the decision to leave every plan, the practice likely would have lost approximately 17.5% of its annual revenue, which is not easily replaced.
Why dental insurance is complex
All businesses, including dental practices, tend to make processes more complicated over time. One of the biggest reasons is that they continually add protocols, steps, and safeguards to avoid problems. While well intentioned, these additions often create unnecessary complexity.
Dental insurance is no exception. Staff members spend considerable time filing claims, using the correct codes, following payer-specific requirements, and managing appeals. Much of this effort can be streamlined. Practices can reduce complexity by implementing the following strategies:
- Use the right codes. Practices should perform an annual review and update their insurance codes. We frequently see practices using outdated codes that result in lower reimbursements and lost revenue. Online and live coding courses, as well as resources from national dental organizations, provide updates on new codes and their appropriate use. Practices can also contact insurance companies directly to verify the correct codes for specific procedures.
- Standardize routine claims. Most dental insurance claims are remarkably similar, yet many practices submit different information for the same procedures. This inconsistency is counterproductive and wastes valuable time. Practices should develop standardized claim protocols with boilerplate documentation automatically included for routine procedures. We frequently see claims rejected simply because required information was omitted, and many of those claims are never refiled with the correct documentation.
- Create standard written appeals for denied claims. Most practices rarely appeal denied claims, allowing insurance companies to avoid payment. By establishing a standardized process to review and appeal every denied claim when appropriate, practices can significantly increase collections. In many cases, this can generate tens of thousands of dollars in additional annual revenue.
- Start over. Rebuild your insurance processing system from the ground up. Eliminate unnecessary steps, identify inefficiencies, and create a streamlined process for filing claims and appeals with complete documentation. This approach saves substantial administrative time for front desk staff and insurance coordinators while making claims processing more efficient and successful.
We recently worked with a practice to implement these strategies. The result was several hours of administrative time saved each week and more than $70,000 in additional annual revenue from the same cases that had previously been submitted.
Dental insurance plans can be one of the more frustrating aspects of practice management, but they are here to stay. Rather than accepting unnecessary complexity, practices should focus on simplifying their insurance processes. The strategies outlined in this article can help reduce administrative time, improve efficiency, and increase revenue by ensuring that more claims are approved and paid.
Dr. Roger P. Levin is CEO of Levin Group, a leading practice management and marketing consulting firm. To contact him or to join the 40,000 dental professionals who receive his Practice Production Tip of the Day, visit LevinGroup.com or email [email protected].
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
