5 questions before you enter a new in-network agreement

A poll by the American Dental Association Health Policy Institute in February 2024 found that one out of six dentists left an insurance network between January and March 2023.¹Whether it’s reduced payment reimbursements, increased claims denials, or bad customer service, there are many reasons why insurance carriers may be missing the mark with their in-network providers.

As a former general dentist in private practice and the current president and CEO of a national insurance carrier, I’ve had the opportunity to see things from both perspectives—the challenges that providers and office administrators face, as well as the complexities of the insurance industry.

I can assure you that most insurance carriers are not trying to make your life difficult. They don’t want to take away your ability to grow financially or make decisions about your patients’ care. We value what you do to improve oral and overall health and strive to improve your experience with us.

Here are five questions to help evaluate whether entering a new in-network agreement with an insurance carrier is right for you.

Evaluate what to do by asking these 5 questions

1. Is the insurer invested in improving your overall experience?

Things such as responsiveness, self-service tools and other technology, regular reviews of claims policies, and proactive outreach are good indicators that a carrier is committed to improving the experience for dentists and office management staff.

Responsiveness: How quickly does the carrier representative get back to you and how happy are you with the response? If you’re constantly having to check in or follow up or are not satisfied with the general outcome, that’s a good indicator of how you’ll be treated.

Self-service tools and other technology: When insurers invest in tools, platforms, infrastructure, and other technologies that make engaging with them easy, it’s a good sign that they’re dedicated to improving your experience. A simple enhancement like offering convenient access to information can do a lot to streamline interactions for office managers and patients.

Proactive communication: Carriers that offer best-in-class service proactively reach out to get your team’s input on various matters, including satisfaction with resolution of issues, claims processing, and payment policies. They place high importance on constructively addressing any feedback.

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2. What’s the insurer’s philosophy toward patient care?

Partnering with an insurer provides more than just access to their members; they also offer continuing education classes, educational resources on the oral-systemic connection, and other benefits. When you partner with a company that’s dedicated to elevating oral and overall health—not just with dentists but in the communities they serve—you’ll find a partner that’s focused on improving health outcomes by offering benefits that support better oral care.

3. Does the carrier have an efficient delivery service and a good record of issues resolution?

What’s the company’s process for credentialing/recredentialing and onboarding, and what’s their track record for processing claims? Having a better understanding of how they approach service, the average time it takes for each step, and what’s needed from you will help you evaluate whether the carrier’s obligations are realistic and if the partnership is the right match. Look for insurers that have high success ratings for dentist credentialing, claims processing accuracy, and issue resolution.

4. What kind of practice support is available?

From credentialing and onboarding to claims submissions and everything in between, you and your team will have questions or feedback, so it’s important to know who to contact. For some insurers, that can mean different departments. Look for a carrier with a dedicated provider relations team. Since their main role is to work closely with dental offices to provide personalized service, they’ll be more familiar with any recurring issues and should be able to resolve them quickly.

5. Is the insurer offering network tiers and reimbursement structures that best support your practice’s goals? Are they prominent in your area?

Wherever you are in your practice, find a carrier who’s committed to having conversations to understand your practice’s objectives and determine the best network tier to match your needs. Whether you’re established or just starting out, an insurer with more network tier options can adapt to meet changing practice priorities. To help your office achieve optimal results, select a network tier that has the right mix of patient volume and fair reimbursement rates.

You’ll also want to consider how well-known the insurer is locally and what percentage of your patients it insures. Carriers with strong employer relationships in the area servicing a healthy percentage of your patients will have a greater positive impact on your bottom line.

As the insurance industry becomes increasingly competitive with more companies and networks, deciding what in-network agreement is right for you can be a challenge. Taking the time to gain a greater understanding of how your potential carrier partner fares on these important topics will help make your decision a little easier, for both you and your practice’s future.

Editor's note: This article appeared in the November/December 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

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