Two Moves to Outsmart Dental Insurance
By Benjamin Tuinei
Let’s be honest: dealing with dental insurance companies feels a lot like playing chess against a pigeon. You spend hours preparing strategy, studying the board, planning three moves ahead…and the pigeon still knocks over every piece, poops on the board, and struts around like it won.
But here’s the good news: you can win this game—or at least stop losing so much—if you position yourself strategically. After nearly 20 years in the trenches helping practices across America fight the good fight, I’ve learned this:
You don’t beat insurance by working harder.
You beat insurance by playing smarter.
And that starts with two key moves.
1. Negotiate Your PPO Fees (Yes, You Actually Can Do That)
Some dentists still believe PPO fees are written in stone, carved into tablets, and delivered from a mountain by someone with a booming voice.
Nope.
>>> PPO fees are negotiable.
>>>>> They’ve always been negotiable.
>>>>>>> And they’re becoming more negotiable every year.
Why?
Because insurance companies know providers are leaving networks in record numbers. They know the cost of losing a dentist is far higher than giving one a reasonable increase. And they definitely know the “we’re considering termination” email is the new “we need to talk” that sends shivers down a payer’s spine.
But here’s the catch:
Negotiation isn’t about sending one email and hoping for a miracle. It’s about understanding how umbrella networks overlap, how leasing arrangements work, and how to strategically position your fee schedule so you’re not accidentally accepting a 30% discount from a network you didn’t even know you were in.
(If PPO structures were a family tree, we’d need a DNA test just to figure out who’s related to who.)
>>> When done correctly, negotiations create margin.
>>>>> Margin creates breathing room.
2. Consider Out-of-Network Strategies (Our Version of Freedom)
Every practice — yes, even yours — should at least explore out-of-network strategies.
I’m not saying you should rip the band-aid off tomorrow and go full fee-for-service while holding a freedom flag and shouting “Liberty!” (Though if you do, please send video.)
But you should absolutely:
Identify which plans are unprofitable
Evaluate how many of your patients actually rely on those plans
Train your team to communicate the out-of-network advantage
And create a phased, strategic transition—not a panic-driven one
What happens when dentists move out of network intelligently?
>>> It’s magical.
Doctors rediscover profitability, case acceptance improves, patients trust the practice more, and providers no longer need to diagnose dentistry based on what insurance will approve, deny, or philosophically disapprove of that day.
And here’s the real kicker:
>>> When large numbers of dentists go out of network… PPO fees rise.
>>>>> When large numbers stay in network… PPO fees fall.
You tell me—which direction do you want your profession heading?
The Bottom Line
If you want better reimbursement, more control, and less daily frustration, there are only two roads: Negotiate. Or liberate. But whatever you do, don’t stand still. Insurance companies are counting on your stagnation. You’re the practice owner. You’re the one building something meaningful. And the great news? You’ve got options. Use them. If the pigeon can strut around like it’s winning… it’s time for dentists to strut right back.
Ben Tuinei is an Expert Dental Insurance Analyst and one of our nation’s foremost authorities on maximizing dental insurance reimbursements. Ben would welcome a call or email from you if you would like his input on your insurance challenges.
Ben Tuinei | ben.tuinei@gmail.com | (888) 808-4513 | veritasdentalresources.com
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J. Robert “Bob” Brooks, CEPA, CBI
J. Robert “Bob” Brooks, CEPA, CBI, leads Practice Endeavors, an Ohio-based practice brokerage and dental realty company. His company provides practice owners with the tools they need to prepare well for life after practice ownership and to find the best price/best fit buyers for their seller clients. Bob was integral in starting the first of its kind dental practice broker credentialing for the International Business Brokers Association.