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Dental Insurance Contract Concerns

common contract clauses

When you receive a dental insurance contract, you should read, understand and evaluate it thoroughly to determine if signing the contract is a sound business decision. Below we highlight common clauses within provider contracts and offer suggestions that you may use to negotiate with the payer. We offer you a comprehensive list of questions to consider as you read the contract: What every Dentist Should Know Before Signing a Dental Provider Contract (PDF).

The ADA Survey of Dental Fees provides an analysis of self-reported fees by procedure code from a nationwide, random sample of dentists. [ADA member exclusive]

Take advantage of the free service we offer:

Contact Analysis Service

Resources for handling contract issues

  • Contract Negotiations Guide [PDF]
  • How PPO Processing Policies Affect Claim Adjudication - Parts 1 & 2 [Webinars]
  • A Carrier's Perspective on Audits [Webinar]
  • The Growing Impact of PPO Leasing on Your Practice [Webinar]

Contract issues to consider

  • Hold Harmless Clause
  • Recoupment Clause
  • Affiliated Carrier Clause
  • Most Favored Nations Clause
  • Automatic Renewal Clause
  • Compliance with Policies and Procedures Clause
  • Plan Participation Clause
  • Influencing Members' Choice of Dentists Clause