• Sylvie Haber

Dental Reimbursement

Updated: Oct 22



Dental insurance - the dreaded two words most dental practices hate hearing. Dealing with dental insurance comes with the headaches of finding out the benefits and intricacies of your patients’ dental plans but also, staying on top of being reimbursed for the services provided for the procedures completed. This can cause a lot of stress for a dental practice team but dental insurances still don’t make the process easier especially when it comes to the reimbursement rates.


It is common knowledge that cost of supplies have increased, overhead costs have increased, new regulations that require new equipment add to costs, and paying staff has increased. But the one thing that has not changed are reimbursement rates from insurance, which turns into reduction of rates.


To show evidence about the reduction of rates, the following information is from two offices that Global Team Solutions consults for and both offices are in-network with different dental insurances. Below are the statistics from both offices:


Office #1 is in network with Delta Dental, Humana, and MetLife. 29% of patients have Delta Dental with the office having a reduction of fees of 64%, 17% of patients have Humana with the office having a reduction of fees of 53%, and 16% of patients have MetLife with the office having a reduction of fees of 47%.


Office #2 is in network with Delta Dental, Aetna, Cigna, MetLife, and Humana. 35% of patients have Delta Dental with the office having a reduction of fees of 55%, 16% of patients have Aetna with the office having a reduction of fees of 36%, 10% of patients have Cigna with the office having a reduction of fees of 38%, 10% of patients have MetLife with the office having a reduction of fees of 43%, and 5% of patients have Humana with the office having 34% of reduction of fees.


As shown by the numbers above, it’s a hard pill to swallow to see the percentage of write-offs compared to the number of patients that these offices have. What’s going on you might be thinking? There’s a reimbursement crisis happening. An analysis done by the ADA shows that most fees paid to dental offices are significantly lower than what the normal market fee is. Even more shocking is that in that same study, the ADA found that only 60% of the $75 billion that is spent on dental insurance is going towards dental care.


As the reimbursement crisis continues in the dental industry, there are solutions that you can utilize that best fit your office. One solution that many offices are gravitating towards is creating an in-house membership plan where it is customized to fit your office's needs. Another option is hiring a consultant that specializes in negotiating with dental insurance companies to increase your reimbursement rates. Although there is lobbying done to have dental insurance companies to keep up with the changing market and increase the reimbursement rates, it is safer to follow what is best for your office and patients. After all, insurance should not dictate care for patients.


Sylvie Haber, Consultant


Sylvie first entered the dental field through her mother, who is a dentist. She grew up attending conferences and many dental meetings. Watching her mother’s passion and love of dentistry, Sylvie grew to love the profession as well. After, she earned her MBA in Healthcare Administration from Loma Linda University.  She completed the ADA ‘s Executive Program in Dental Management and also became a Fellow of the American Association of Dental Office Management. Sylvie enjoys seeing dental offices thrive, become more productive and run smoothly under her guidance through management and coaching.

Sylvie can be reached at: sylvie@gtsgurus.com




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