Negotiating Fee Schedules with Insurance Companies: Sample Letter

Mastering Negotiations: Sample Letter for Dental Practices to Negotiate Fee Schedules with Insurance Companies

Are you looking at negotiating fee schedules with insurance companies sample letter? In the labyrinth of managing a successful dental practice, one of the thorniest challenges remains the negotiation of fee schedules with dental insurance companies. The stakes are high, and the process often feels like speaking a foreign language without an interpreter.

But here’s the truth every dental professional should engrain: effective negotiation can uncover buried treasure in the form of increased revenue, better patient retention, and a stellar, competitive market presence.

In the dental sphere, your aptitude at negotiation is as crucial as your expertise with root canals or crowns. Thus, we unveil an invaluable tool for your arsenal—a meticulously crafted sample letter that embodies everything a successful negotiation strategy is built upon.

Understanding the Negotiation Process

Negotiating fees boils down to how you present your value proposition to insurance companies while respecting the mutual benefits attained. Here’s the walkthrough guide.

Terms and Concepts

Before you start the talk, know your terms. UCR (Usual, Customary, and Reasonable) fees, effective dates, and termination clauses are your jargon for the day. Familiarize yourself with them and weave them into your letter.

Preparation and Research

Data is your best friend. Arm yourself with figures on the average fees in your locality, and build your argument with concrete metrics about your practice’s quality and efficiency.

Sample Letter Template for Negotiating Fee Schedules

A well-crafted letter can be the difference between a successful negotiation and a missed opportunity.

The Whys and Hows

Here are the reasons to craft your negotiating fee schedules with insurance companies sample letter. Your letter should present a clear case of why fee adjustments are necessary for your practice to continue providing quality care. Cite specific reasons, such as the increased cost of living, new services you offer, or improved technology that requires additional investment.

Tone and Language

Your letter should exude professionalism and courtesy. It’s not just the fees you’re negotiating; it’s a relationship you’re aiming to nurture.

Tips for Effective Negotiation

Effective negotiation is part art, part science. Here are the brushstrokes you need to nail it.

Building Rapport

Start on the right foot. Open your letter by acknowledging the partnership and express your practice’s commitment to serve the shared goal.

Showcasing Strengths

Your practice might be top-tier in various competencies. Don’t be shy—this is no time for modesty. Articulate your strengths elegantly but assertively.

The Art of Compromise

Negotiation should be a give-and-take. Be prepared to meet somewhere in the middle without compromising the financial health of your practice.

Benefits of Successful Negotiations

Here’s the carrot at the end of the stick. What’s in it for you after the ink is dry?

Revenue and Profitability

Shoot for the stars—they might just be within reach. An adjusted fee schedule can mean significant jumps in your annual revenue.

Patient Satisfaction and Retention

When your practice’s financial health improves, so does your flexibility and ability to cater to patient needs.

Competitive Market Advantage

In an industry where the bottom line is key, your practice can gain a significant upper hand in the local market through strategic fee negotiations.

Negotiating Fee Schedules with Insurance Companies: Sample Letter

[Your Practice’s Letterhead]


[Insurance Company’s Name]

[Insurance Company’s Address]

[City, State, ZIP Code]

Attention: [Name of the Contact Person],

[Their Title]

Dear [Contact Person’s Name],

I am writing on behalf of [Your Practice’s Name], a dedicated provider in the [Your Location] community. Our commitment to delivering exceptional dental care has been unwavering, as we continuously strive to enhance our services and ensure the utmost satisfaction of our patients.

It is in this context that we approach [Insurance Company’s Name] with a proposal to reevaluate our current fee schedule. This adjustment is critical for us to maintain the high standards of care our patients are accustomed to, and to incorporate advanced dental technologies that significantly improve treatment outcomes.

Our request is backed by comprehensive market research indicating that the current fees are below the usual, customary, and reasonable (UCR) rates for our locale, especially considering the unique blend of services and quality we offer. Furthermore, an adjustment is justifiable due to the increased cost of living and operational expenses affecting our practice.

We are keen on continuing our valued partnership with [Insurance Company’s Name], aiming to achieve mutually beneficial outcomes. Thus, we propose a meeting to discuss a revised fee schedule that reflects the quality, efficiency, and value we bring to our shared clientele. It is our belief that this adjustment will enable us to further our investment in patient care technologies and methodologies, ensuring that we continue to meet and exceed the healthcare benchmarks in our community.

We appreciate your attention to this matter and are prepared to provide any additional information required. I look forward to your positive response and to setting up a meeting at your earliest convenience to discuss this proposal in detail.

Thank you for your time and consideration.


[Your Name]

[Your Title]

[Your Practice’s Name]

[Contact Information]


This letter exemplifies a professional yet assertive approach, articulating the necessity for fee schedule adjustment while emphasizing the mutual benefits it brings. Remember, the goal is not just to secure better rates, but to sustain and enrich the collaborative relationship you share with the insurance provider.

Drop PPOs, Create a Patient Membership Plan

Dropping PPOs and introducing a membership plan can laud a practice with a multitude of benefits unrivaled by traditional insurance clauses. Here’s the lowdown on how to do it right.

Membership Plan Primer

What is a membership plan, and why is it pivotal when dealing with PPOs? This section offers insights into an alternative, patient-centered approach to dental care.

Research and Analysis

Evaluate your current patient demographics, their insurance providers, and the services they regularly avail of. Gather data on your practice’s income from PPO patients and identify potential loss or gain after switching to a membership model.

Designing an Alluring Membership Plan

Include routine preventive care in your plan and offer discounts on additional services. Design tiers with varying levels of coverage to cater to different budgets while ensuring profitability.

Marketing Your Plan

Spread the word through social media, email marketing, and in-office promotions. Highlight the savings and convenience your membership plan offers patients compared to traditional insurance plans.

Practice Benefits

A membership plan powered by BoomCloud allows for a more personalized patient experience, a predictable revenue stream, and fewer third-party complications, empowering the dentist and patient relationship.

Additional Practice Benefits

Reducing dependency on PPOs and shifting towards a membership-driven model not only diversifies income sources but solidifies the financial foundation of a dental practice. Here are further benefits of this strategic move:

Reduced Dependence on PPOs

Leveraging a membership plan diminishes a practice’s reliance on PPOs, granting greater control over service pricing and patient care standards. This strategic pivot minimizes the bureaucratic constraints and fee limitations often imposed by insurance companies, allowing practices to set fees that accurately reflect the quality and value of their services.

Recurring Revenue

A membership plan transforms unpredictable income streams into predictable monthly revenue. Patients paying a monthly or annual fee for access to certain dental services ensure a consistent cash flow, reducing the financial unpredictability associated with insurance reimbursements. This model also encourages long-term patient relationships, as members are more likely to return for regular check-ups and preventive care.

Examples of Success

Numerous practices have reported increased stability and patient satisfaction after implementing membership plans. For instance, a practice in Seattle saw a 30% increase in yearly revenue after transitioning away from PPOs to a membership model. Another example is a small practice in rural Georgia that experienced a significant boost in patient loyalty and a decrease in administrative burdens related to insurance claims processing.

Building on the successes outlined, consider the transformative impact of a dental practice successfully enrolling 567 patients into its membership plan at $40 per month. This strategic move not only signifies a remarkable milestone in patient engagement and trust but also establishes a robust financial foundation for the practice. With 567 members contributing monthly, the practice boasts a consistent Monthly Recurring Revenue (MRR) of $22,680. When projected over the year, the Annual Recurring Revenue (ARR) surges to an impressive $272,160. This predictable revenue stream is invaluable, providing the practice with financial stability and the confidence to invest further in patient care and technological advancements.

Furthermore, the paradigm shift to a membership model encourages a deeper commitment from patients towards their dental health, as evidenced by members spending, on average, three times more than non-members. This increase in spending is not merely a financial metric; it represents a heightened engagement with the practice’s services, from preventive care to elective procedures. Such financial and engagement metrics underscore the profound impact of transitioning to a membership plan, offering a compelling testament to the model’s efficacy in fostering financial stability, enhancing patient loyalty, and elevating the standard of care provided.

Implementing a patient membership plan not only secures a more predictable revenue stream but also fosters a more direct, value-based relationship between patients and practices. This innovative approach underscores a commitment to quality care and patient satisfaction, distinguishing your practice in a competitive healthcare landscape.

Watch a Demo of BoomCloud™

The BoomCloud™ Platform helps practices create & grow patient membership plans! Practices that grow their membership plan generate predictable recurring revenue, reduce dependence on PPOs & increase case acceptence by 3X. Build a better practice with your own membership program!

dental membership software

Sample Membership Plan Brochure

Dear Patients,

We are excited to introduce our new patient membership plan, designed exclusively for you! This comprehensive program is an alternative to traditional insurance plans that dictate the type and frequency of dental care you receive. Our goal is to provide affordable, high-quality care while maintaining the utmost convenience for our valued patients.

Here’s what you can expect from our membership plan:

  • Coverage for routine preventive care, including cleanings, exams, and x-rays
  • Discounts on additional services such as fillings, crowns, and extractions
  • No deductibles or annual maximums
  • No waiting periods or pre-authorizations
  • Flexible payment options to fit your budget

Our membership plan eliminates the hassle of dealing with insurance companies and empowers you to take control of your dental health. You’ll receive personalized care from our experienced team, who will work closely with you to create a customized treatment plan.

Enrollment is simple and can be completed at our office or online. We offer individual, couple, and family plans to cater to all our patients’ needs. Plus, as an exclusive member, you’ll receive priority scheduling and special promotions throughout the year.

We believe that our membership plan offers unparalleled benefits to our patients and strengthens the dentist-patient relationship. Please contact us for more information or to enroll in our program today!


[Your Practice’s Name]

[Contact Information]

Note: Include details such as coverage options, pricing, and terms and conditions in the brochure. So, why wait? Say goodbye to PPOs and join our membership plan today! Together, let’s prioritize your dental health and ensure long-term satisfaction. Thank you for choosing us as your trusted dental care provider.

-[Your Name]

[Your Practice’s Name]

[Contact Information]


I hope this article about negotiating fee schedules with insurance companies sample letter was valuable to you and your practice. Diving into the waters of fee schedule negotiations can be daunting, but with the right approach and tools, it becomes less of a challenge and more of an art form that can redefine the success of your dental practice.

I encourage each dental professional to see negotiation not as a one-time hurdle but as an ongoing dance—each step, a chance to shine and carve your place in the thriving dental landscape.

Remember, every successful negotiation is a story. Craft your narrative—one where your practice emerges not just profitable, but as a beacon of value-driven, patient-centric dentistry. The pen, after all, is in your well-gloved, well-informed hands.

Additional Resources

For those interested in further enhancing their understanding and implementation of dental membership plans, the following resources provide valuable insights and tools:

Leveraging these resources can help dental practices not only establish but also effectively manage and expand their membership plans, ultimately leading to improved patient satisfaction and practice profitability.

Download "The Million Dollar Membership Plan" E-book!

Learn tactics and strategies from practices that have built a million dollars in recurring revenue from their membership subscriptions alone! Creating a patient membership plan is the smartest strategy to implment in your practice. You will increase patient satisfaction & loyalty, Increase predictable recurring revenue & improve your case acceptence by 3X with members. Download the book Now!