BUSINESS BITES - Written Fee Renegotiation Request
Most dentists treat their PPO fee schedules as fixed. They aren’t. You can ask a plan to raise the contracted fees you agreed to when you joined its network — and most owners never do, which is exactly why a schedule set five years ago quietly turns into a pay cut as overhead climbs. The tool for fixing that is a written fee renegotiation request, and it’s the lowest-effort lever you have on PPO revenue. Before you ever consider dropping a plan over low fees, this is the first move.
What it is
A written fee renegotiation request is a formal letter to a dental plan asking it to increase the reimbursement on your participating fee schedule. The “written” part matters: it creates a record, routes to the right department, and is far harder to brush off than a phone call. The ADA makes the same point from the other direction — any assurances a payer's representative makes should be put in writing, so paper protects you throughout the process.
Why it’s worth the effort
Insurers will not offer you an increase on their own. You have to track and initiate the process yourself, revisiting your fee schedules every 12 to 24 months. And the payoff is real without changing anything clinical. Even small wins on your top procedures can add up to thousands in additional collections each year, with the same patients and the same schedule.
How to make an effective request
Target your top codes, not “everything.” Focus on the highest-volume, highest-revenue procedures that drive most of your production with that plan. It’s especially worth asking when a plan pays more than about 20% below your full fees.
Build the case with data. Gather regional fee benchmarks, your own full fees, your rising overhead, and the time since your last increase, and use all of it to tell your story. You’re making a business case, not lodging a complaint.
Send it to the right person. Identify the payer's provider-relations representative assigned to your region and direct the request there, rather than into a general inbox.
Be concrete. For each procedure, state your current contracted fee and the exact fee you’re requesting, so there’s nothing left to interpret.
What to expect
Go in with realistic expectations. The ADA is candid that negotiating with plans can be an uphill, frustrating process that rarely results in getting everything you want, and the first offer you receive may not be the best one. Responses vary from outright denials to partial increases, so follow up and don’t take the first “no” as final.
Leverage helps. Dentists in areas with fewer competing providers tend to gain more concessions than those in saturated markets, and a busy practice, an in-demand specialty, or a credible willingness to drop the plan all strengthen your hand. One detail worth including: ask whether the carrier leases its network and whether your revised fees will apply to those leased plans. This silent-PPO issue can otherwise undercut the raise you just won.
The one hard rule
This must be an individual negotiation, every time. Federal antitrust law prevents the ADA from negotiating fees on behalf of dentists, though individual dentists are free to negotiate on their own, and you cannot compare or share fee schedules with other practices to coordinate. Practice by practice, always.
Before you walk away from a plan over its fees, ask it for more. A written renegotiation request costs a letter and an afternoon of homework. Insurers will never volunteer the increase themselves, and a better schedule can change your entire stay-or-drop calculation. Put a fee-schedule review on the calendar every year or two and treat the ask as routine, because the plans certainly aren’t going to remind you.
