Navigating the Ever-Changing Insurance Landscape

AJ Acierno, DDS


The concept of dental insurance sounds good in principle. Patients have the benefit of reduced fees and out of pocket expenses, and doctors who join the networks see an influx of patients. Unfortunately, many of us who have been practicing for years know that this is a fallacy. The reality is that insurance can put an enormous burden on your practice.

According to the ADA, 92% of dentists are contracted with an insurance provider. To improve the success of your practice, many consultants will tell you simply not to take insurance. But in today’s world with marketing, group practices, and educated patients, this is easier said than done.

In the last 10 years, the prevalence of our patient population having insurance has increased substantially. In fact, 73% of patients have some type of dental insurance. These people often will choose in-network providers because of the cost savings that going to one of these offices provides.

Although the number of covered patients has increased, patient benefits have not. In 1980, the yearly benefits for patients on average was typically between $1000 and $1,500. Back then, $1,500 was an ample amount of money to get dental work completed. More than 30 years later, though, and we are still seeing the same $1,500. That amount of money doesn’t get a patient very far in 2017.

Another issue that has an indirect effect on insurance is student debt. The average student debt for dental school in 2016 was more than $260,000. When young dentists buy a practice, they are adding an enormous practice loan to this student debt. These practitioners have to start making money immediately to pay these loans. The result is that these dentists are essentially forced to sign up for many different insurance plans.

What You Can Do

So, if your office accepts insurance, what needs to be done to remain successful?

First and foremost, know the plans that you are signing up for, and, when possible, try to negotiate prior to signing. Understand that some insurances will give you an enticing fee schedule when you first become a provider, only to lower it down the road. Always make sure to pay attention to this and renegotiate when your contract is up.

Next, you need to make sure your front desk is billing, filing, and collecting well. You are already taking a discounted fee by being in an insurance network. If the office is also doing a poor job collecting, you are only making the financial situation worse.

Probably the most important thing that will determine the success of your office taking insurance is how well you have systems and processes in place. Since fees are lower, you have to see more patients in the same amount of time to stay profitable. But the patient’s experience and treatment quality must not be diminished. This requires the office to be extremely efficient. Training your staff in repeatable systems and processes allows everyone to be on the same page and improve teamwork.

In 2017, taking insurance in a dental office is becoming less of a choice and more a necessity. This does not have to be a hindrance to the practice, though. With the right planning and strategy, an office can still be highly successful and still deliver excellent care.

Dr. Acierno, CEO of DecisionOne Dental, graduated from the Creighton University School of Dentistry in 2001. He founded DecisionOne Dental Partners, a network of dental professionals, in 2011. Also, he practices at Acierno Dental in Schaumburg, Ill. He recently presented “Health Care Has Lost Its Soul” at North Park University’s TEDx Talk about the changing landscape of healthcare. Dr. Acierno can be contacted at

Disclosure: Dr. Acierno is CEO of DecisionOne Dental.

Related Articles

How to Communicate with Insurance Companies in 2017

How to Build a Practice That’s Less Dependent on Dental Insurance

Outsourcing Billing Can Improve Cash Flow