063: The Delta Dental Insider Dentists Need to Hear | Michael Cembrola

Dental insurance fee negotiation is how your practice gets carriers like Delta Dental to raise what they pay you, and most offices are not doing it nearly enough. If you haven't touched your fee schedules in six, eight, or even ten years, you are leaving money on the table every single day. Staffing costs aren't going down. Supply costs aren't going down. As more practices weigh dropping PPO networks in 2026, knowing how in-network reimbursement really works has never mattered more. On The Real Talk of Dental, host Brandi Marzolino, a 20-year dental industry veteran and leadership coach, sits down with Michael Cembrola, a former Delta Dental sales executive with 20 years in dental benefits who now helps dentists negotiate fees with insurance companies. Michael explains why you should review your reimbursements every two years, why dental fraud and abuse cost an estimated $12 to $15 billion a year in the US, and how the Model Dentist tool he helped build scores every dentist in a network across 25 clinical and patient metrics. You'll also learn how self-funded and fully insured plans drive your prophy reimbursement, and who actually sets that $1,000 annual maximum. This is the episode where we stop picking a villain and start having the real conversation. You’ll learn:Dental insurance fee negotiation timing: why Michael Cembrola recommends reviewing your reimbursements every two years, and what to do when a carrier tells you no the first time you ask. Should dental offices drop insurance? How your patient mix, the carriers in your area, and your growth stage decide whether staying in-network still makes sense for your practice. Dental insurance fraud, waste, and abuse: why an estimated $12 to $15 billion is lost every year in the US, and how honest coding mistakes by office staff quietly add to it. Model Dentist quality scoring: how the tool ranks every dentist in a network from tier one to tier five using 25 metrics like complication rates, fillings versus crowns, and continuity of care. Who really sets your $1,000 annual maximum: why employers, not insurance companies, choose the plan design, and how that misconception fuels patient frustration at your front desk. Self-funded versus fully insured dental plans: how employers paying the cost of care directly keeps prophy reimbursement low, and why that makes dental insurance fee negotiation so tough. Value-based care in dentistry: what it means to pay dentists more for appropriate, preventive care at the right time, and why dental still runs about ten years behind medical. 🔗 Join the community and submit your anonymous questions:https://www.therealtalkofdental.com🔗 Learn more about The Empowered LeadHERship Program for Women in Dental:https://leadhershipexperience.com/🔗 Boundary Boss GPT:https://leadhershipexperience.com/boundarybossWe talk about:00:00 Why a Delta Dental insider isn't the villain 03:00 Former Delta Dental exec thoughts on dental insurance today 05:00 Should dental offices drop insurance? 07:30 Dental insurance fraud costs $12 to $15 billion yearly 11:00 Is dental fraud mostly intentional or accidental? 13:00 Who really sets your $1,000 annual maximum? 14:30 Dental insurance fee negotiation: how often should you ask? 19:00 Model Dentist scores every dentist on 25 metrics 25:30 What does value-based care mean in dentistry? 30:30 Dentists vs insurers: who really holds the power? 32:00 Is low prophy reimbursement hurting dental hygiene? 33:30 Self-funded vs fully insured dental plans explainedGot an insurance horror story or a fee negotiation confession? Leave Brandi an anonymous voicemail for The Real Talk of Dental at https://www.speakpipe.com/TheRealTalkofDental Connect with MichaelLinkedIn: https://www.linkedin.com/in/mikecembrola/Connect with meLinkedIn: https://www.linkedin.com/in/brandimarzolino/Instagram: https://www.instagram.com/brandi.marzolino/https://courageandjoyatwork.com/https://leadhershipexperience.com/Phone: 616-682-6222#DentalInsurance #DentalInsuranceNegotiation #PPONegotiation #DeltaDental #DentalPractice #DentalPracticeManagement #DentalFraud #DentalBilling #DentalCoding #DentalHygiene #DentalHygienist #ValueBasedCare #DSO #DentalOfficeManager #DentalLeadership #DentalIndustry #DentalPodcast #TheRealTalkOfDental