Dear ADA: Reimbursement rates
Association uses advocacy, education to address decreased reimbursement
Dental insurance issues are often rated as one of dentists’ biggest challenges.
In response to an ADA Health Policy Institute poll in late 2025, more than half of dentists reported that one of their top concerns looking ahead to 2026 was related to insurance, including low insurance reimbursement rates and delayed or denied payments.
This ADA News series aims to address some of those challenges. Dear ADA will feature answers to common insurance-related questions the American Dental Association receives from members to help provide clarity and direct members to additional resources.
The answer to this month’s question is provided by Bertram Hughes, D.D.S., vice chair of the ADA Council on Dental Benefit Programs.
Dear ADA: My insurance reimbursement rates dropped this past year, and HPI data shows many dentists are concerned about low reimbursement rates. Why isn’t the ADA doing something to stop these decreases or negotiate better rates with insurers?
Dr. Hughes: As a practicing dentist, I completely understand and share the frustration you’re describing. Many of us have experienced real declines in reimbursement over the past year, even as our overhead, staffing costs and supply expenses continue to rise.
According to HPI’s Q4 2025 State of the U.S. Dental Economy Report, reimbursement rates are not keeping pace with overall inflation and practice expenses, putting a significant fiscal squeeze on dental practices. Seeing data from HPI simply confirms what we are already feeling day to day in our practices.
As volunteer leaders for the ADA, my colleagues and I are very aware of the many issues affecting the dental profession. We are consistently trying to address member concerns surrounding reimbursement pressures and, ultimately, patient access to care. While the ADA cannot directly negotiate reimbursement rates on behalf of individual dentists or practices, we do provide toolkits to help dentists navigate the insurance world. Unfortunately, the Federal Trade Commission and anti-trust regulations hinder the ADA from taking a more proactive approach.
Dentists retain the ability to evaluate their own participation in dental benefit plans. Some best practices would be to periodically review contracts, negotiate individually and assess whether a plan continues to meet the clinical, financial and operational needs of your practice. In situations where a contract no longer aligns with those needs, some dentists thoughtfully consider modifying or ending network participation, always weighing the impact on patients, staff and long term practice sustainability.
That said, the frustration is real and widely shared across the profession. Many dentists feel caught between declining reimbursement and rising costs. While the ADA cannot simply stop rate decreases, it does continue to raise awareness of the problem and advocate for the profession within the boundaries it is allowed to operate. This includes advocating at the state and federal levels, working with employers to provide more robust dental coverage, leading educational initiatives, and helping to develop innovative models to improve sustainability for the dental profession.
Many reforms that support stronger transparency from insurance companies have resulted from ADA advocacy at the National Council of Insurance Legislators and Congress. In 2025, 37 dental insurance reform laws were passed in 18 states. This followed the 16 laws that were passed in nine states in 2024. These laws — supported by the ADA’s State Public Affairs program — addressed downcoding, bundling and virtual credit card opt-in provisions.
The ADA’s Contract Negotiation Guide offers step-by-step preparations, sample questions and checklists to help support members as they negotiate payer agreements. Other ADA resources address the appeals process, offering written appeal templates, documentation checklists and tips to navigate multiple levels of appeal. Another ADA document provides guidance on how to properly terminate a network agreement. For dentists looking to learn the basics, the ADA offers an introductory guide that provides general information on dental benefit programs. Resources are available at ADA.org/dentalinsurance.
There are steps dentists can take now to address their reimbursement concerns. They can use the negotiation guide referenced above to help them review contracts, ask the right questions and understand clauses surrounding downcoding, bundling and fee schedules. Other tips include:
• Always submit your full fee so you can understand write-offs.
• Evaluate your top 20 procedures and what you write off by payer.
• Start with one payer and negotiate.
• Don’t forget to train your staff on communications if you choose to leave a network.
The ADA’s Medicaid fee schedule comparisons and HPI data can help support negotiations as well.
Dentists can also leverage ADA coding resources, including CDT kits, webinars and companion guides, to audit their coding and documentation. These resources are available at ADA.org/cdt, and kits can be purchased at ADAStore.org. If a claim is denied, the ADA’s appeal and claim rejection guides can help dentists file strong appeals. The ADA and many partner states also offer insurance concierge services for more nuanced insurance issues.
