Introduction

Negotiating PPO fees is a crucial aspect of running a financially successful dental practice. Many dentists accept insurance reimbursement rates without question, but failing to regularly renegotiate these fees can result in lost revenue and reduced profitability. So, how often should you negotiate your PPO fees, and what should you consider during the process?

The Ideal Frequency for PPO Fee Negotiations

Most experts recommend that dental practices negotiate their PPO fees every 1 to 2 years. However, the exact timing depends on several factors, including:

• The expiration of existing contracts.

• Market changes and inflation.

• Reimbursement trends within your region.

• The financial health of your practice.

Why Regular PPO Fee Negotiations Are Essential

1. Insurance Reimbursement Rates Change

   • PPO fee schedules are not static; they fluctuate over time. If you don’t negotiate, you could be stuck with outdated reimbursement rates that fail to cover rising operational costs.

2. Increased Costs of Running a Practice

   • Equipment, supplies, staff salaries, and overhead costs continue to increase. Without adjusting PPO reimbursements, your profitability may suffer.

3. New Providers and Market Conditions

   • If your practice has added new providers or expanded services, you may qualify for higher reimbursement rates.

4. Better Leverage with Insurance Companies

   • PPO networks are more willing to negotiate with providers who regularly assess and challenge their fee schedules.

Steps to Successfully Negotiate PPO Fees

1. Analyze Your Current PPO Fee Schedule

   • Compare your reimbursements across multiple PPOs and identify the lowest-paying plans.

2. Determine Your Break-Even Point

   • Calculate the minimum fees required to cover your costs and maintain profitability.

3. Research Industry Benchmarks

   • Review typical reimbursement rates for your region using tools such as the National Dental Advisory Service (NDAS) or Fair Health Consumer.

4. Prepare a Proposal

   • Develop a clear request, backed by data, highlighting the need for fee increases. Include:

     • Your UCR (Usual, Customary, and Reasonable) fees.

     • Cost increases in overhead, supplies, and staff wages.

     • The number of patients you serve within each insurance network.

5. Engage in Negotiation with PPO Networks

   • Contact provider relations departments and be persistent. If an insurer refuses a rate increase, inquire about alternative contract options or tiered plans.

6. Review Your Contracts Carefully

   • Avoid automatic renewals without reassessing fee schedules and contract terms.

7. Drop Low-Paying PPOs If Necessary

   • If a PPO consistently underpays and negotiation efforts fail, consider dropping the plan and focusing on higher-paying insurers or fee-for-service patients.

Conclusion

Regularly negotiating your PPO fees—ideally every 1 to 2 years—can significantly impact your practice’s financial health. Staying proactive in discussions with insurance providers ensures that you receive fair compensation for your services, allowing your practice to remain profitable and sustainable. By understanding your costs, leveraging data, and confidently negotiating, you can maximize reimbursement rates and enhance the overall success of your dental 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