If you’re an in-network provider with dental insurance companies, you’ve probably looked at your reimbursements and thought, “This just doesn’t cover the cost of delivering quality care anymore.”

You’re not wrong—and you’re not alone.

That’s why more and more dentists are exploring PPO fee negotiations as a way to regain control over profitability without dropping plans entirely. But timing matters.

So, is there a best time of year to negotiate your PPO fee schedule? The answer is yes—and understanding when (and why) to negotiate can give you a serious edge.

The Best Time of Year to Negotiate PPO Fees

Late Q3 to Early Q4 (September–November)

This is often considered the sweet spot for PPO fee negotiations.

Here’s why:

• Insurance companies are wrapping up their fiscal year and reviewing network performance.

• Some plans are more open to change during this time because they’re prepping updates for the new year.

• If approved, new fees can go into effect January 1, aligning with the patient benefit cycle.

Pro Tip: Start the process in September or October to give time for back-and-forth communication and fee approval by year-end.

Other Strategic Times to Negotiate

Around Contract Renewal Time

Some PPO contracts have set terms (1–2 years). If you're approaching your contract anniversary, that's a perfect time to request a fee review.

Check your:

• Contract start date

• Renewal/termination terms

• Required notice period for amendments

If your contract renews automatically, you’ll likely need to request a fee adjustment at least 60–90 days in advance.

Before Dropping a Plan (or While You’re Considering It)

If you’re on the fence about staying in-network with a low-paying plan, don’t drop it yet—use it as leverage.

Example:
“Our practice is reassessing our participation due to current reimbursement levels. We’d like to stay in-network, but it must be financially viable. Are you open to reviewing our fee schedule?”

Insurers may be more flexible if they know you’re considering termination.

When Not to Negotiate

January–March

The first quarter is typically the least effective time to start negotiations. Many insurers are:

• Processing new enrollments and renewals

• Focused on volume and claims administration

• Less responsive to fee change requests

You can still request fee reviews during Q1, but response times are often slower, and approvals may be delayed until mid-year or later.

Tips for Successful Fee Negotiation (No Matter When You Start)

1. Know Your Numbers

• Run a report of your top 20–30 procedure codes by volume and revenue.

• Highlight underpaid procedures that impact your profitability most.

• Present your UCR fees alongside current PPO reimbursements.

2. Justify Your Request

• Include rationale: increased overhead, cost of materials, staff wages, inflation.

• Mention years in practice, patient volume, or market comparisons.

• Be respectful but firm—present yourself as a partner, not a commodity.

3. Be Strategic About Which Plans to Target

Start with:

• Plans that send you a high volume of patients but offer low reimbursement

• Plans you’re willing to walk away from if negotiations stall

• Plans with no “most favored nation” clauses limiting what you can charge others

4. Leverage Third-Party Help If Needed

There are companies and consultants that specialize in PPO fee negotiations. If you’re too busy or overwhelmed, outsourcing can be a smart investment—especially if they can negotiate across multiple plans for you.

Final Thoughts: Timing Is a Tool—Use It Wisely

Negotiating PPO fees is about more than just numbers—it’s about strategy and timing.

By aligning your fee negotiation efforts with:

• Year-end insurance cycles,

• Contract anniversaries,

• Or pivotal business decisions (like dropping a plan),

You maximize your leverage, improve your chances of approval, and protect the financial health of your practice.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com