Many dentists feel like PPO fee schedules are set in stone—but that’s not the case. Insurance companies are businesses too, and like any business, they respond to leverage, strategy, and data. If you’re looking to negotiate your PPO fees, it’s not just about asking for more—it’s about showing why you’re worth more.

Here’s how to strengthen your position and improve your chances of a successful PPO fee negotiation.

1. Understand the Landscape: Why PPOs May Be Willing to Negotiate

Insurance companies don’t increase fees simply because you ask—they do it when they see value or risk. The main motivators for them are:

• Keeping high-producing providers in-network

• Maintaining sufficient access to care in specific zip codes

• Avoiding gaps in coverage for large employer groups

• Preserving relationships with practices that provide broad service offerings

In other words: they negotiate when they have something to lose.

2. Know Your Leverage Points

If you want PPOs to accommodate your demand for a fee increase, you need to bring something to the table. Here are key leverage points that get results:

Zip Code Leverage

If you're in an area where there’s a shortage of providers, PPOs may be more flexible to retain or attract your practice. Rural areas, fast-growing suburbs, or urban neighborhoods with limited access can tip the scales in your favor.

Tip: Use provider directories to check how many in-network competitors are within a 5- to 10-mile radius.

Production Volume

High-producing practices are expensive for insurers to lose. If you process a high volume of claims, insurance companies want to keep that business in-network.

Tip: Include 12 months of claims volume (by plan) in your proposal to show the financial impact you represent.

Specialty Services or Broad Scope

If you offer procedures that most other GPs don’t—like implants, Invisalign, molar endo, or sedation—that can reduce the insurance company’s need to credential additional specialists. This gives you negotiating power.

Multiple Locations

Have more than one office? PPOs may be more willing to negotiate with DSOs or multi-location practices to secure wider coverage.

Threat of Dropping the Plan

If you’re prepared to drop a plan, and you can prove your practice doesn’t rely heavily on it, you can use this as serious leverage—but use with caution. This only works if you’re actually willing and able to follow through.

3. Build a Data-Driven Proposal

Don’t just send a letter asking for a raise. Come to the table with a professional, compelling proposal that includes:

• A list of the top 20 CDT codes you bill, along with your current contracted fees and your requested fees.

• Claims volume for that plan over the last 12 months.

• A comparison of regional UCRs (usual, customary, and reasonable fees) to show how underpaid you may be.

• Any other value-adds: number of new patients, five-star reviews, unique services, etc.

Pro Tip: Use fee analysis software or services to benchmark your reimbursements against national and local averages.

4. Work with a PPO Negotiation Service (Optional, but Helpful)

Fee negotiation firms (like Unitas, Five Lakes, or PPO Profits) have established contacts with insurers and know how to structure proposals that get results. They can also help clean up your PPO participation, remove hidden leasing networks, and optimize your mix of plans.

5. Timing Is Everything

Some plans only accept fee negotiations once a year or during specific renewal windows. Others may be more flexible, but timing it alongside your annual fee schedule update or credentialing review may yield better results.

6. Be Prepared for Pushback—and Be Patient

Negotiations can take 60–120 days or more. Insurers may counter with partial increases or tiered offers. Stick to your value, remain professional, and don’t expect instant success—but know that persistent, data-backed efforts often pay off.

7. Don’t Be Afraid to Walk Away

If a PPO is significantly underpaying you, and your data shows the plan brings in low production with high overhead, it may make sense to phase it out. You can often retain many of those patients with proper communication, especially if you remain non-contracted but still bill their insurance.

Final Thoughts: You Have More Power Than You Think

Negotiating PPO fees isn’t just for big DSOs—it’s possible for any practice that understands its value, leverages its data, and presents a professional case. Whether you get a modest bump or a major overhaul, each increase helps reduce write-offs, improve margins, and reward the care you provide.

Don’t settle for outdated fees. You’ve earned more—now go get it.

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