PPO Negotiation Solutions

We Level The Playing Field Between Dental Practices and Insurance Companies

Is Your UCR Fee Schedule Undercutting Your Own PPO Contracts?

You negotiated the fee increase. Your own fee schedule may be quietly cancelling it.

The Rule Most Practices Forget

Dental claims are paid at the lesser of your UCR fee or your contracted fee. Always.

If you negotiate a $1,150 contracted fee on a crown but your office fee for that crown is $1,100, the carrier pays based on $1,100. The extra $50 you negotiated never arrives. Multiply that across procedures, carriers, and a full year, and the loss is substantial.

How It Happens

No one sets out to undercut their own contracts. It happens gradually:

  • Office fees haven’t been reviewed in two or three years.
  • Negotiated PPO increases outpace UCR updates.
  • The team worries that higher fees will mean larger write-offs on the ledger.
  • A startup sets fees once at opening and never revisits them. Our own data shows 7 out of 10 dental startups don’t set their UCR fees correctly.

We’ve seen a practice hesitate to raise fees over write-off concerns, let its UCR drift below several of its contracted rates, and lose more than $82,000 in a single year. It wasn’t a bad contract. It was its own fee schedule.

Your Fee Schedule Is Also Evidence

Since late 2024, carriers have had greater visibility into the fees practices actually submit on claims. If you submit a discounted fee instead of your full UCR, you’re showing every carrier that the lower number is what your work is worth.

That becomes a problem at the negotiating table. Your fee schedule isn’t a price list. It documents your value.

A Five-Step Self-Check

  1. Pull your 20 most frequently performed procedures.
  2. For each one, list your UCR fee next to your highest contracted PPO fee.
  3. Flag any procedure where a contracted fee equals or exceeds your UCR.
  4. Benchmark your UCR against the National Dental Advisory Service (NDAS) report. We recommend no less than the 70th percentile.
  5. Review fees at least once a year and again after every successful negotiation.

If step three turns up even one flag, money is already leaving the practice.

Fix the Foundation First

A fee negotiation built on an outdated UCR schedule is a gain you won’t fully collect. That’s why every engagement we take on starts with an audit of your UCR fees against your market and your contracts, before we ask a single carrier for more.

Find out whether your fee schedule is costing you. Request your complimentary PPO Revenue Assessment.

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