Do you know why I am a fee for service office?
Because insurance companies don't give a damn about what the correct treatment is for an individual patient. They only care that the codes relating to the patient's treatment are submitted correctly. And if there's a code submitted that doesn't follow that company's rules or guidelines, it is denied.
For example, I used to take Medicaid for frenectomies (it was important to me that I participate in our community's safety net). I even lost money every time I did a Medicaid frenectomy. But one day Medicaid said that I did too many frenectomies (uh, yeah, it's what I do), and they said from then on I would need the patient's pediatrician's permission (who is likely not trained in oral function/tethers), among other things, for them to approve it. So my staff spent many extra hours over the next 3 months making sure we had every signature and document needed for each of our Medicaid patients. Guess what. I didn't get a single penny from Medicaid for those patients. Would you keep being an in-network provider for an insurance company that doesn't pay you?
Well that's an extreme example, but it is the same concept with all insurances. Would you be an in-network provider if they paid you 25% of what you're worth? 50%? 80%? What if they ultimately were the ones who told you which procedures were necessary or unnecessary for your patients (who they've never met). Would you keep working with them?
I became a dentist because from age 5 I thought teeth were freaking cool, and I wanted to