If you’re like most dental practices, your expenses are increasing, and you’re  facing a steady stream of lower reimbursements from insurance companies year after year. Outlined below, are some key steps that you can take to negotiate higher fees from insurance companies that can get you paid more without additional chair time!


Common misconceptions about this process:

– Insurance companies won’t negotiate

– The PPOs don’t need me

– I’m just a number

– I have no leverage


Steps to negotiating with PPOs to get paid more:


1.) Create an insurance profile.

– Organize a list of PPO plans that you currently participate in, when you joined them, and create a report illustrating your top 25-30 utilized codes (80-90% of your revenue and know where the money is).

– Reasons you joined them: New practice, need new patients, losing patients. It’s a good idea to review the benefits of participating in PPOs.

– Find and create a list of the network recruiters and network managers by PPO plan. These are the people to communicate and negotiate with.


2.) Prepare to negotiate.

– Identify your leverage: Location, Specialists/General Dentist (do you have specific skills that set you apart?), availability (do they need you more than you need them?).

– Create a negotiation letter that illustrates your leverage, describes why you’re important to the network, and that you want to continue participating with them, but the current fee schedule is insufficient. To get the best results, you’ll need data to make your case.

– After you’ve completed the previous steps, the key is to negotiate with the right person who can actually agree to and sign off on a higher paying schedule. Send the letter certified when possible and create a paper trail.


3.) I received a proposal with an increased fee schedule, what next?

– Don’t accept the first offer! Compare proposed schedule versus your old one and if your top 25-30 codes are not significantly increased, submit a counter proposal. Counter at least once.

– Once you’ve accepted a new schedule, get an official schedule with the insurance company’s logo, implementation date, and expiration date.


4.) After your new schedule is implemented, what’s next?

– Audit claim submissions to make sure your increased fees are being paid for at least two months.

– Repeat this process every 18-22 months!

The steps to negotiating higher paying schedules are to build your insurance profile, identify and create your leverage, write a negotiation letter and send it to the right person, review and counter offer proposed fees, and audit for accuracy.


5.) Legalities in negotiating that, as a sole practitioner, you should be aware of (due to anti-trust laws):

You cannot call your colleagues (or band a group of dentists together) to review their fees, boycott collectively, or negotiate as a group, etc. with the carriers. It may sound unfair, but this is one way that the carriers have an upper hand in negotiating.

Apex Reimbursement is not under the same restriction, so we are able to see multiple schedules by specialty and insurance company in order to help us create negotiating leverage on behalf of our clients. You can see it as a sports agent who represents multiple athletes of the same position and knows what they are getting paid.


Interested in making more money without adding chair time? Please call us at 410-710-6005 or CONTACT US online!