When paperwork becomes a reason to leave

A practice owner sits down at the end of the month with the figures and a folder of insurer letters: a request for more documentation, a claim sent back, a prior authorisation still pending. The fees have not moved in a long time. At some point the question stops being how to work with the network and becomes whether to stay.

What US practice owners reported

In September 2024, the American Dental Association's Health Policy Institute sent a panel survey to 2,437 members; 997 responded, an adjusted response rate of 41.2%. Across the practice owners in the sample, 26.1% said they had already left some insurance networks.

In the same survey, 227 owners who had left a network answered a question about their reasons, and could choose several. Of those 227, 98.7% chose the level of reimbursement and 57.3% chose administrative burden.

These figures describe a group selected by what it had already done, not dental practices in general. And the survey does not show that administration alone caused anyone to leave; only that, for many of the owners who left, it was one of the reasons.

Canada's public plan

In October 2026, the Canadian Dental Association published From Coverage to Care, an assessment of the Canadian Dental Care Plan (CDCP). It draws on a survey of 1,081 dentists carried out in April and May 2026 through provincial and territorial associations.

In the CDA's 2026 survey, 57% of those who answered rated the plan's administration as burdensome, 68% rated it harder than the administration of private insurance, and 74% chose prior-authorisation denials as one of their concerns. The report does not make clear how many dentists answered each question.

These are perceptions, not work timed by the clock, and they come from an association with a policy position. The CDA report also records improvement: most authorisation requests are now handled within 5–7 business days.

In their own words

Interviews show how the work looks from inside a practice. In JAMA Health Forum in 2025, Elani and colleagues reported interviews with 67 dentists in eight US states, held between August 2022 and July 2023, about participating in Medicaid; 46 participated and 21 did not.

They described unpredictable claims, delayed reimbursement, difficult prior authorisations, and time spent explaining the limits of coverage. In some accounts, the wait for an authorisation reached two months; others described easier processes in their states. These are reported experiences, not averages, from a purposive sample that over-represents women, younger dentists and Medicaid participants.

In Ireland, Leavy and colleagues, in PLOS One in 2026, reported 19 interviews held between November 2024 and February 2025 about public contracts for primary dental care. Six were with practising dentists (three current DTSS contractors, two former, one who had never contracted); the others were with seven managers or officials and six academic experts.

Interviewees described inconsistent approval decisions, work on payment claims, and long explanations to patients about refusals and paid alternatives, which they linked to frustration and strained relations with the health system. Six dentists are not a sample of clinics, and the study measured neither hours nor cost.

The same research programme earlier published a realist review in Health Policy in 2025, drawing on 62 sources, 41 of them about the UK. It describes how contract requirements, approvals and oversight, together with budget pressure and a perceived loss of control, bear on dentists' satisfaction and commitment to public services. It synthesises mechanisms from English-language OECD sources; it is not a statistical meta-analysis.

What the evidence supports

Each figure here belongs to its own country, year and denominator, and none should be combined with another. In the only survey here that asked owners why they left, reimbursement was cited almost universally. Administration is the theme that keeps appearing beside it: in survey answers, in interviews and in the review.

SoliumOS is built for the administrative side of that picture. It prepares the work around care inside the clinic's own cloud, and the clinic's team keeps the final say on every step. It does not change what an insurer pays, and none of the studies above measured it.

Sources

• American Dental Association, Health Policy Institute (2024). Economic Outlook and Emerging Issues in Dentistry — 3rd Quarter 2024. September 2024.
• Canadian Dental Association (2026). From Coverage to Care. October 2026.
• Elani HW, Prakash N, Tipirneni R (2025). Barriers and Facilitators of Medicaid Participation Among Dentists. JAMA Health Forum 6(11): e254403.
• Leavy P, Daly B, Ford J, Burke S (2026). ‘Us and them’. PLOS One 21(7): e0341786.
• Leavy P, Symmons SM, Mockler D, Fleming P, Daly B, Ford J, Burke S (2025). How and why do health system factors influence general dentists’ participation in publicly funded, contracted primary dental care services: A realist review. Health Policy 153: 105248.