FAQ

Who is Apex Reimbursement Specialists?

Our mission is simple: to stop dental practices from “leaving money on the table.” We serve a national client base ranging from solo practitioners to large Dental Service Organizations (DSOs), helping them navigate the complexities of insurance reimbursements.

Does Apex Reimbursement Specialists provide PPO Fee Negotiations for dental practices?

Yes. Apex Reimbursement Specialists excel at PPO fee negotiations on behalf of their dental clients to strategically raise reimbursement rates with insurance companies. Apex has negotiated over $1B PPO revenue lifetime.

How is Apex Reimbursement Specialists different from other fee negotiation companies?

• Insider Expertise: Our leadership team includes industry veterans with over 30 years of experience in dental insurance, auditing, and clinical practice.
• Data-Driven Advocacy: We utilize a proprietary database of national fee schedules and market trends to provide practices with quantifiable leverage during negotiations.
• National Reach: Apex has negotiated over $1B of PPO revenue in most states, and worked with close to 5,000 dental practices.

Does Apex Reimbursement Specialists offer credentialing services?

• Yes. Apex Reimbursement Specialists has credentialed thousands of dental providers and have enrolled them with most insurance companies.

What kind of increase can I expect when using Apex Reimbursement Specialists?

On average, we have seen increases of 8%-12% on direct insurance contracts.

Do you focus on the codes that give us the most revenue?

We focus on your highest-utilized codes (like cleanings, exams, and crowns) so that even a small percentage increase translates to significant annual revenue. In one case, we secured percentage increases as high as 145% for a specific client!

Do you negotiate with third party networks?

We analyze whether you should be in a direct contract or accessed through a “leased” network (like a PPO umbrella).A practice can achieve double digit percentage increases, but it comes with risks as well that you need to analyze prior to making a decision.

What is a UCR? 

UCR stands for Usual and Customary Fees. This is your practice cash fee schedule.

Can you determine if our UCR is set correctly? 

Apex conducts a UCR Fee Analysis to ensure your office’s standard fees aren’t holding you back.If your office fees are set too low, insurance companies have no reason to offer you more. Apex helps you set your fees at the correct percentile for your specific zip code to create the necessary leverage for negotiations.

How long does the credentialing process take?

Anywhere from 30-90 days for direct contracts

How long does it take to negotiate PPO fees?

4 to 6 months

Does Apex help determine which insurance companies to term with?

Yes

How long does it take to get started? Is there a wait time?

No, once we have all the documents needed, we begin working on your behalf

Will the insurance companies raise my fees more since I haven’t negotiated in 5 years?

Not necessarily. Most carriers will increase incrementally

Why is it important to enroll with PPO Plans?  

Enrolling with PPO plans is important for the following reasons: 

• Instant patient base. Insurance companies are powered by their members. When you are in network with a PPO plan you access to these members.
• Directory Presence: When you join a network, you are listed in their provider directories. This is often the first place they look for a dentist.
• Reduced Acquisition Cost: With a PPO, the “cost” is the write-off you take on the fee, but you only “pay” that cost when a patient actually sits in the chair. Contrast that with social media, SEO or AI marketing which has a higher cost associated with patient acquisition. 

How can I maintain profitability when PPO reimbursements aren’t keeping up with rising supply and labor costs? 

To maintain profitability, practices should renegotiate PPO fee schedules every 18–24 months to ensure reimbursements reflect current 2026 labor and supply costs. It is equally vital to “untangle” leased network contracts to prevent insurance carriers from defaulting to the lowest available payment schedule. 

How did my practice end up ‘In-Network’ for a plan I didn’t join? 

This can happen through a process called network leasing or shared network agreements. When you sign a contract with one major insurance carrier, that carrier often has a “reciprocal” agreement that allows other insurance companies to “rent” their provider list (i.e. Metlife/Aetna).

I recently resigned from a PPO plan—why am I still appearing as ‘In-Network’ in their directory?

We see this often with our clients. This usually occurs because of network leasing provisions in your other active contracts. Even if you terminate your direct agreement with “Plan A,” you may remain in-network if you participate in a larger “umbrella” or shared network that “Plan A” is allowed to access.

To truly become out-of-network, you must identify and untangle every third-party connection that grants that carrier access to your practice. Until those secondary links are severed, the insurance company can continue to list you in their directory and reimburse you at their discounted rates.

Why am I being reimbursed at a lower rate than what is listed in my primary PPO contract?

This typically happens when a carrier identifies that your practice is accessible through multiple network agreements. If you are enrolled in both a direct contract and a shared or “leased” network, the insurance company will almost always default to the lowest available fee schedule to minimize their payout. Without a strategic “untangling” of these overlapping contracts, your higher negotiated rates can be bypassed by lower-paying third-party agreements you may not even realize are active.

How can I tell if my practice is unknowingly being paid from a lower or outdated fee schedule?

We encourage our clients to review and audit their EOB (Explanation of Benefits) line by line, comparing the “Allowed Amount” against your most recently negotiated fee schedule. If you notice inconsistencies—such as different carriers paying the exact same rate for a procedure or payments matching a schedule from several years ago— there is reason to dig deeper to find and resolve the issue that is causing this discrepancy. To be certain, you should request confirmation of participation from your major carriers to see which “umbrella” networks are currently linked to your tax ID, as these are often the source of hidden lower rates. 

Is it possible to significantly increase my practice’s profit margins just by updating my PPO schedules?

Absolutely. Because your fixed overhead (rent, utilities, and base salaries) remains the same regardless of what insurance pays, a 5% to 10% increase in PPO fees often translates to a 20% to 40% boost in net profit. By updating your schedules to reflect current market rates, every additional dollar negotiated goes directly to your bottom line without requiring you to increase your patient volume or work additional hours.

Why is contract optimization just as critical as fee negotiation for increasing collections? 

Negotiation secures a higher rate on paper, but optimization ensures that the rate is processed correctly. Without “untangling” your contracts, an insurance company can use overlapping network agreements to bypass your new, higher fees and pay you through a lower-paying third-party connection instead. Optimization eliminates these “backdoor” pathways, ensuring your practice is always reimbursed at the highest possible negotiated rate.

How does Revenue Cycle Management (RCM) streamline everything from claim submission to final patient payments?

Revenue Cycle Management (RCM) creates a synchronized workflow that ensures every procedure is accurately coded, billed, and collected. By auditing EOBs in real-time, RCM identifies and contests improper write-offs and “down-coding” before they become lost revenue. This proactive approach prevents claims from sitting in Accounts Receivable (AR) and ensures patient collections are based on accurate insurance estimates, resulting in faster payments and a healthier bottom line.

What proactive steps can I take today to protect my practice’s financial health against declining PPO reimbursements?

To protect your practice’s financial health, you should immediately perform a comprehensive fee analysis to compare your current reimbursements against 2026 market benchmarks. Following this, you must audit and “untangle” your network participation to close the loopholes that allow carriers to pay you at lower third-party rates. Finally, commit to renegotiating your contracts every 18–24 months, ensuring your revenue keeps pace with rising overhead and inflation rather than falling behind. This is where Apex Reimbursement can provide tremendous value.