📍 Welcome back to No Silver Spoons. My name is Sara Beth Herman. I'm your host, five-times CEO and CEO of Dentistry Support. I wanna talk about something today that I know a lot of dental offices are tired of talking about, insurance, , and honestly, I do get it. I understand why your front office team is so frustrated.

I understand why they hate verifying benefits. I understand why they hate sitting on hold. I understand why they hate posting payments, chasing claims, explaining estimates, correcting EOBs, and being the overall person who has to tell a patient, "Unfortunately, your insurance didn't pay what we expected." It is not fun.

I also understand why so many dentists and office managers are saying, "Forget it. Let's just go out of network." That conversation is everywhere right now. You see it in dental Facebook groups. You hear it at conferences. You see it in comments under billing posts on different popular blogs. Everyone is exhausted.

Everyone is tired of low reimbursements, denied claims, frequency limitations, downgrades, missing information, pre-auth confusion, and patients who think their insurance is a guaranteed one hundred percent coverage. I get it. I understand the emotion behind, "Let's just go out of network." But I want to say something that might be a little uncomfortable.

Going out of network is not a strategy if your team does not understand what is happening inside your revenue cycle. It might be the right move for some practices, for sure. I'm not saying it's never the answer, but it's not the answer just because everyone's mad,

Because if your team cannot confidently verify benefits, explain benefits, collect patient portions properly, document limitations, track claims, appeal denials, and communicate clearly with patients while you are in-network, then going out-of-network does not magically fix that, and you're still all gonna be mad.

It just changes the pressure. The root issue is not always the insurance company. Sometimes the root issue is that the team is overwhelmed or under-trained, burnt out, constantly interrupted, or trying to do a very technical job while also answering phones, checking patients in, checking patients out, presenting treatment, collecting balances, managing the schedule, and just overall putting out fires all day long.

It's the part that we don't talk about enough. We keep calling insurance verification a front desk task, and it's not. Insurance verification is a revenue protection. It's patient communication. It's treatment acceptance. It's claim prevention. It's collections. It's trust. And when it's done poorly, the practice is paying for it.

The team is paying for it. The patient is paying for it. A patient hears, "Your insurance is active." What they think is, "Great, this is covered." But we know that those are not the same thing. Active coverage does not mean a crown is covered a hundred percent. Active coverage does not mean the waiting period has been met.

It doesn't mean the annual max is available. It doesn't mean the buildup will be paid. Active coverage does not mean SRP will not be denied for frequency. It also doesn't mean the patient understands their portion, and this is where so many practices are actually losing money, and not because they're bad practices, not because their team doesn't care, but because the system is more complicated than the training that most team members have received.

And in twenty twenty-six, this is getting even harder. We are seeing more payer scrutiny. We are seeing more denials. We're seeing more documentation requirements. We're seeing more AI and automation being sold into dental billing, and we are seeing more practices looking for a magic button And I wanna be very clear, there is no magic button.

There are tools, there are systems, there is software, there is AI, there are integrations, and some of them are useful. Some of them are impressive. Some of them, they do save time,  but they do not replace judgment. They do not replace knowing what to ask. They do not replace understanding how a plan actually processes.

They do not replace someone catching that the insurance rep gave vague information. They do not replace someone knowing that covered and payable are not the same thing. And I'm not saying that because I own Dentistry Support.

I'm saying it because I've seen behind the curtain. A lot of these software companies have reached out to Dentistry Support. They've asked us to partner with them. They've asked us to help them make the product work correctly. And some of them have great sales teams.

They know exactly how to show the highlights. They know how to make it sound simple. But what they do not always lead with is the limitation. They don't say, " This still needs human review." They don't say, "It depends on payer data quality." They don't say, "This may not catch plan-specific limitations." They do not say, "Your team still needs to understand what they're looking at."

And that is where practices get hurt because the practice thinks, "Great, we bought a solution." But what they really bought was a tool, and a tool in the hands of an overwhelmed, undertrained, negative, burnt-out team is not a solution. It's just another thing they now have to manage. So when I say the one hundred thousand dollar front desk mistake, I'm not talking about one person making one mistake one time.

I'm talking about the pattern, the missed waiting period, the missed frequency limitation, the annual max that was already used at another office, the secondary insurance that was never verified correctly, the pre-auth that was treated like a guarantee, the downgrade that was never explained, the claim that went out without the right attachment, the EOB that got posted incorrectly, the patient estimate that was presented with too much confidence and not enough clarity, individually, these look like small things.

But over a year, they become write-offs, delayed payments, upset patients, team conflict, doctor frustration, cash flow problems, and this is where attitude matters. I know dental insurance is frustrating, and I am not asking anyone to pretend that it is not. But walking around the office saying, "I hate insurance.

Insurance is terrible. This is stupid. I hate doing this," does not help the patient. It does not help the team. It does not help collections. It does not help the doctor. It does not help the practice make better decisions. It only reinforces chaos, and patients do feel that. They may not understand dental billing, but they can absolutely feel when a team is annoyed, unsure, dismissive, or irritated, and it matters because the patient already does not understand their plan.

They already think insurance in the dental world works like medical. They already think covered means paid in full. They already think the dental office controls what the insurance pays

So if our team is frustrated and unclear, the patient becomes frustrated and unclear, and now we have two problems. We have the insurance problem, and we have the communication problem, and honestly, sometimes the communication problem is actually more expensive because patients do not just get upset about balances.

They get upset when they feel surprised or misled or like no one explained it. So the goal is not to promise perfection. The goal is clarity. The goal is to say, "Here's what we verified. Here is what insurance told us. Here are the limitations we found, and here is what we estimate. Here is what could change.

Here is your responsibility if insurance pays differently." This is a completely different kind of conversation. This is what builds trust because we're laying it out. We're not using a bunch of filler words or niceties that change what the patient could interpret that we're saying. We're laying it out.

But your team cannot have that conversation if they do not know what they're doing. And that is the part practice owners have to be honest about. If you have high turnover, your insurance system is vulnerable.

If your front office is constantly negative, your insurance system is vulnerable. If only one person knows how to verify benefits, your insurance system is vulnerable. If your team is relying on screenshots, guesses, outdated breakdowns, or that's how we've always done it, your insurance system is vulnerable.

If your team cannot explain downgrades, waiting periods, missing teeth clauses, frequency limitations, alternate benefits, annual maximums in plain English or whatever native language you have in your practice, your insurance system is vulnerable. And that does not mean your team is bad.

It means they need support. That support might be better training. It might be better systems. It might be outsourcing. It might be a third-party partner. It might be dentistry support. It might not be. You have options. But please do not keep putting highly technical revenue cycle responsibilities on people who are already drowning and then act surprised when they are negative.

That negativity is information. It's telling you the system is not working. It's telling you the team does not feel confident. It's telling you the process is too dependent on memory, personality, and one strong employee. And that's where I think practices need to mature in twenty twenty-six. We have to stop treating insurance as a necessary evil and start treating it like a business function.

If you accept insurance, then insurance is part of your business model. You do not have to love it, but you do have to know how to manage it. And if you cannot manage it consistently in-house, then get help because the answer cannot always be, "Let's just go out of network. Insurance sucks. I hate insurance."

It's just not always the answer. Now, sometimes it is the right strategic move to go out of network. But if you go out of network because you are frustrated without understanding your numbers, your patient base, your communication systems, your collection process, and your team's ability to present value, you may just trade one set of problems for another.

The better question is, do we actually understand the insurance we are accepting? Do we know which plans are profitable? Do we know which plans create the most denials? Do we know which procedures are getting downgraded? Do we know where our claims are getting stuck?

Do we know how many patient balances are caused by weak verification? Do we know whether our team is trained or just surviving? That's where the money is. That's where the root issue is, the answers to those questions. And I'm gonna encourage you to pause and rewind and listen to me ask the questions again and write them down This is why insurance verification is not a checklist item.

It's not just a simple software we attach, we run the software, the software tells us yes or no. It's a leadership thing. Because when a practice owner says, "My team hates insurance," my first thought is not, "Well, they need a better attitude." My first thought is, what have they been asked to carry without enough support?

Because if someone is constantly being blamed by patients, pressured by the doctor, interrupted by the phone, expected to know every payer rule, and given no consistent training, of course they're frustrated. That's human. But we can't stay there. We can't build successful practices around frustration.

We have to build them around competence, and competence creates confidence. Confidence changes the tone. And when the tone changes, the patient experience changes. So here's what I want you to take away from this episode, my that's good moment for today. If your practice is losing money to insurance, do not only look at the insurance company.

Look upstream at verification, documentation, coding, narratives, payment posting, your adjustment reports,

 Look at your AR. Look at your team turnover. Look at the way your team talks about insurance when patients are nearby. Look at whether your systems rely on knowledge or hope because hope is not a billing strategy and irritation is not a revenue cycle system. If your team is equipped, if they're trained, supported, and clear, insurance becomes manageable.

Still annoying sometimes? Yes, absolutely. Still imperfect? Yes, absolutely, but it's manageable and if your team is not equipped, then stop expecting them to magically perform like experts. Lean on experts. Bring in support. Train them. Audit the process. Outsource the parts that are draining the practice.

Protect your team from burnout and protect your patients from confusion because the practices that are gonna win in twenty twenty-six are not necessarily the ones that scream the loudest about insurance. They're the ones that understand it well enough to make smart decisions. They know when to stay in-network.

They know when to renegotiate, when to drop a plan, when to outsource, when software actually helps. They know when human expertise is still required and most importantly, they know that the front office is not just the front desk. The team is protecting your revenue every single day. So the next time someone says, "Let's just go out-of-network.

I hate insurance. Insurance sucks. It's the worst thing ever. Dental insurance is the enemy. It's just a necessary evil," I want you to pause for a second Because all of those things individually sometimes right? . Sometimes it's the right move to go out of network. Sometimes it's fair to have an opinion about something.

But I want you to first ask, do we know what is actually broken that's giving us this feeling that we have to constantly repeat? And why are we just settling for our team members having negative conversations about anything that brings in revenue or contributes to the revenue, which is how our business is actually thriving?

If dental insurance went away completely today, would that solve your problems or would a huge portion of revenue no longer exist in your practice because there wasn't a way for that revenue to come in? I want you answering that question and if it doesn't terrify you at the thought that dental insurance would no longer exist because your practice doesn't bring in a penny from dental insurance, then hey, your team's right.

Insurance is terrible. It's fine that they have any conversations because you don't need it. But I bet that isn't the case. I bet you still are willing to accept a check from an insurance company. So we've got to go back to the drawing board and answer some of these questions that we've talked about today so that you can actually get to the root issue and work with your team to make it a better experience for the patients.

If we don't start realizing what's actually broken, we're not making a strategy. We're just reacting. And in twenty twenty-six, reaction is expensive. Nearly eighty percent of dental practices reported increased claim denials or payer scrutiny over the past year. The CDT

twenty twenty-six includes sixty code changes. So coding accuracy and retraining are not optional this year. And more than a quarter of dentists surveyed already dropped insurances, meaning that they're no longer in network in twenty twenty-five, which shows that frustration is real, but it also proves that practices need strategy, not just reaction You guys, we can do this.

We can make our practices successful with insurance and we don't have to have a negative connotation about how it's processed. We'll talk in other episodes, and I have in episodes in the past, about reimbursements and all the aspects that do make insurance not so great. But , let's focus our strategy on the training side.

Let's focus our strategy on who we bring in-house to help us, the better conversations, the positive attitudes, the reality that dental insurance does exist and we've got to stick with it. Thank you so much for tuning in to this episode of  📍 No Silver Spoons. I'll catch you on the next episode