Artificial intelligence (AI) is no longer a futuristic concept—it’s already reshaping the way dental insurance companies operate. As the founder of PPO Advisors and someone who spends every day helping dentists navigate the complex world of PPOs, I see both the promise and the pitfalls of this shift.
Dentists and practice owners need to understand how AI is being used today, how it will impact claims tomorrow, and what steps you can take to protect your practice and your patients.
## The Promise: Where AI Helps
AI is being adopted by major players like Overjet, Curve Dental (Precheck®), DIVA, and Stratus AI. These companies are creating tools that insurance companies use to process claims, verify benefits, and even review x-rays. On the surface, this brings some advantages for dental offices:
– Faster Claims Processing: Automation means claims can move through systems in hours instead of weeks. That translates to quicker payments and fewer frustrated patients waiting on reimbursements.
– Fraud Detection & Accuracy: AI can spot duplicate claims, unusual coding, or questionable billing practices—reducing fraud and keeping insurance costs in check.
– Predictable Approvals: By standardizing claim reviews, AI reduces the risk of human error. In some cases, if your documentation is clear and complete, approvals may actually come easier.
– Improved Patient Experience: Faster verification and eligibility checks mean you can present accurate estimates in real time, improving trust and case acceptance.
## The Pitfalls: Where AI Hurts
While AI sounds like a win-win, dentists need to be cautious. I’ve already seen troubling trends that could hit your practice:
– Clinical Nuance Gets Lost: AI doesn’t “think” like a provider. If a system only sees bone loss measurements on an x-ray, it might deny scaling and root planing—even when the patient clearly needs it.
– Opaque Decision-Making: Insurance companies don’t always explain how their AI algorithms work. This “black box” effect makes it harder for you to appeal or even understand a denial.
– Increased Documentation Burdens: To satisfy AI-driven systems, practices often need to submit more detailed notes, radiographs, and images. What insurers call “efficiency” may just shift the administrative load to your team.
– Risk of Over-Denials: Some dentists are already reporting AI systems denying claims automatically without human review. That means more appeals, more delays, and more frustration.
## Real-World Examples
– Overjet: Already FDA-cleared, its tools are being used by insurers to analyze radiographs for claims decisions.
– Precheck® by Curve Dental: Automates insurance eligibility in real time, reducing front desk headaches but also tightening insurer control.
– AI in Claims Reviews: Dentists have reported cases where AI measures CEJ-to-crest distances or classifies extractions differently than providers, resulting in denials.
This isn’t speculation—it’s happening right now.
## What Dentists Can Do
AI in insurance isn’t going away. The best strategy is to stay proactive:
1. Document Everything Clearly – Provide detailed notes, include images with annotations, and make sure your clinical rationale is spelled out. This increases the chances of your claim being approved—even if a computer is the first reviewer.
2. Watch Denial Patterns – Track which procedures get denied, and how. If you notice a spike in denials for certain codes, it may be AI at work.
3. Educate Your Team – Front desk and billing staff should know which insurers are using AI and how to respond. The more your team understands, the quicker they can appeal or push back.
4. Advocate for Transparency – As providers, we need to push back against insurers who hide behind algorithms. AI should support care, not replace the judgment of a trained dentist.
5. Communicate with Patients – When delays or denials are AI-driven, let patients know. This reinforces trust and makes it clear the problem isn’t with your office.
## Final Thoughts
AI has the potential to make dental insurance processes smoother—but it also creates new challenges that could directly affect your revenue cycle and patient care. My role at PPO Advisors is to keep practices ahead of these changes.
By staying informed, documenting thoroughly, and advocating for fair use of AI, you can protect your practice from unnecessary denials and keep your patients’ trust intact.
The bottom line: AI isn’t the enemy—but blind reliance on it by insurance companies could be. As dentists, you need to be prepared to navigate this new frontier.
By Shelley DeGroff, Founder of PPO Advisors