You did it.

After months of emails, phone calls, spreadsheets, percentile data, and a few moments where you questioned your sanity…
You signed a new PPO contract with significantly higher reimbursement rates.

You printed the new fee schedule.
You high-fived your office manager.
You maybe even told your spouse, “We finally got that increase.”

And then…

You moved on.

Big mistake.

Because what most dentists don’t realize is this:

Negotiation is only half the battle.
Verification is where the money is.

Welcome to “The Default Trap”

At Veritas Dental Resources, we see this all the time.

The carrier agrees to your new fees. The effective date passes. Everyone assumes the system updated correctly.

But behind the scenes?

Their internal claims platform “defaults” back to your old, lower fee schedule.

Not malicious.
Not dramatic.
Just… a glitch.

And that glitch quietly siphons thousands of dollars out of your practice while everyone assumes things are fine.

No alert.
No apology.
No refund check labeled “Oops, our bad.”

Just smaller allowed amounts showing up on your EOBs.

And unless someone is watching closely…
The insurance company keeps the spread.

The Silent Revenue Leak

Let’s break this down with real-world math.

You negotiated:

• D2740 Crown increase from $800 → $1,050

• D4341 SRP increase from $140 → $195

• D2750 Crown increase from $850 → $1,100

You assume the bump is live.

But the EOB says:

Allowed Amount: $800

That’s your old rate.

If that happens across:

• 10 crowns

• 20 SRPs

• 15 posterior crowns

You just lost thousands, in one month.

Multiply that over 90 days?

That’s a five-figure mistake hiding in plain sight.

And here’s the painful part:

The carrier technically approved the higher fees.
You just didn’t enforce them.

The 90-Day Rule

Here’s the strategy we implement:

For at least 90 days after a new contract goes into effect, you audit every single EOB for that carrier.

Not casually.

Not “glance and assume.”

Audit it.

Step 1: Pull the New Signed Fee Schedule
Not the old one. Not what you think it is.
The official, signed, effective-date version.

Step 2: Compare the Allowed Amount
Look at what the EOB actually paid.

Is it the new number?

Or did the system quietly revert to your legacy rate?

Step 3: Challenge Immediately
If it’s wrong:

• Call provider relations

• Reference the contract effective date

• Demand reprocessing

• Document everything

The longer you wait, the harder it becomes to fix.

Why This Happens

Let’s be clear.

Insurance carriers operate on massive claims systems. Updates are layered. Groups vary. Effective dates differ by employer group.

All it takes is:

• A misapplied update

• A group plan not mapped correctly

• An umbrella leasing oversight

• A “system refresh”

And boom, default.

And here’s the uncomfortable truth:

If you don’t catch it, nobody is incentivized to fix it.

Negotiation Without Monitoring = Hope Strategy

Many dentists think:

“We negotiated. We’re good.”

But negotiation without monitoring is just optimism.

And optimism does not reconcile bank deposits.

You worked too hard to let automation undo your leverage.

The Leadership Angle

This isn’t just about coding or billing.

It’s about leadership.

When you negotiate higher rates, you’re telling your team:

“Our work has value.”

If you fail to enforce those new rates, what message does that send?

Your clinical skill.
Your team’s effort.
Your overhead.
Your time.

All deserve accurate reimbursement.

Not “close enough.”

The System You Should Have

Every practice should have:

✔ A designated EOB auditor
✔ A 90-day post-increase checklist
✔ A fee comparison spreadsheet
✔ A reprocessing protocol
✔ Monthly follow-up tracking

This isn’t busy work.

This is profit protection.

The Hard Truth

Most practices never check.

And carriers know it.

Not because they’re evil masterminds.

But because statistically?

Dentists move on.

You get busy.
Production ramps up.
New patients arrive.
Life happens.

And those old rates quietly persist.

Benjamin Tuinei
Founder – Veritas Dental Resources, LLC
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com