Know your numbers before you ask —Dental Fee Schedule Negotiation
PPO fee schedules can go up, but usually only when you ask with data. This guide covers how to review what each plan pays, how to prepare a request, and what to do if the answer is no.
Review your fee schedules first
Pull your top procedures by volume
List the 20–30 procedure codes you bill most often. Those drive most of your PPO revenue, so start there.
Compare each plan's fees side by side
For each code, put your full fee next to what each PPO allows. The biggest gaps show where to focus.
Know your patient mix
Count active patients per plan. That's your leverage. A plan that covers many of your patients has more reason to keep you in network.
Get an outside fee review
Firms that specialize in fee analysis can compare your schedule to others in your area. DentalLink IPA offers a fee review, listed in our partner directory.
How to ask for higher fees
Find the right contact
Ask the plan's provider relations team who reviews fee schedules for your area.
Send a short written request
Name your practice, the codes you want reviewed, your patient count on the plan, and why your practice is worth keeping: access, hours, quality, location.
Follow up on a schedule
Responses can take weeks. Put a follow-up date on your calendar and keep a written record.
Have a plan if the answer is no
If fees don't move, you can stay, limit new patients on that plan, or leave. An in-house membership plan gives patients who lose in-network pricing a reason to stay.
Practices That Got Off The Treadmill.
Select a practice to see how their membership revenue compounded month over month.
“We dropped two of our worst PPO contracts in year one. The membership plan replaced that revenue and then some — and we finally control our own fee schedule.”
- Members
- 612
- MRR
- $38.9K
- ARR
- $467K
- MRR Growth
- +284%
- Write-offs
- -$186K
Fee schedule negotiation questions
- Can dentists negotiate PPO fee schedules?
- Yes, you can ask. Results vary by plan, region and how many of the plan's patients you see. Some plans review requests and some don't.
- How often should I review my fee schedules?
- At least once a year, and whenever a plan changes its fees or your patient mix shifts.
- What if the PPO won't raise fees?
- Look at what the plan is really worth to you per patient. Some offices limit new patients on low-paying plans, and others leave. See our guide on how to drop Delta Dental.
Lower your dependence on any one PPO
See how an in-house membership plan with BoomCloud gives uninsured patients a predictable monthly price.
Own your revenue. Starting this month.
Launch a membership plan, enroll your uninsured patients, and watch recurring revenue land every month — no claims, no write-offs.
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