How to Ask a PPO for a Fee Increase (and What to Do When They Say No)

Key takeaways

• Most dentists never ask a PPO for a fee increase. The plans are counting on that.
• Send the ask in writing, with your cost increases and your top-code comparison attached. Not a phone call, not a complaint.
• Ask for about 10%. It is a request a plan can approve without escalating your contract, and it is real money across a year of volume.
• A yes buys you time, not a permanent good payer. A no has three reasonable responses, not one.

I have never had a PPO show up unprompted with a rate increase. Not once, across more than twenty offices. The fee schedule you signed five or eight years ago is still the fee schedule you are working under unless you ask for something different, and most dentists never ask.

I understand why. It feels like complaining to a landlord who could just as easily raise your rent. You picture a form-letter rejection, or worse, someone flagging your contract for a closer look. In my experience, neither happens. What happens is closer to nothing: a request gets logged, a person reviews it, and you get a yes or a no. The real cost is the hour it takes your office manager to put the packet together.

The case for asking has only gotten stronger. Over the past five years I have watched payroll rise 10 to 20%, supplies climb 15 to 30%, and lab fees go up on top of that. Meanwhile I have fee schedules on my desk from carriers who have not adjusted a rate in eight or ten years. That gap does not close on its own, and a plan has no reason to close it for you. You have to send the letter.

The plans know this trend is running against them, too. The ADA Health Policy Institute's own Q4 2025 numbers show that heading into 2025, 40.7% of dentists said they planned to drop at least one insurance network, and by the end of the year 29.3% said they actually had. Looking into 2026, 35% say they intend to drop at least one more, and insurance issues now rank as dentists' single biggest cited challenge, ahead of staffing and overhead (ADA Health Policy Institute, State of the U.S. Dental Economy, Q4 2025). A plan that ignores a reasonable, well-documented ask is increasingly negotiating against the possibility of an empty network slot, not a captive dentist.

When to ask#

Timing does more work than most dentists give it credit for.

• Ask when you have a full year of your own data for that plan. A packet built on a real twelve-month production pull reads differently than a guess.
• Ask about a plan you intend to keep, not one already on your exit list. If a plan belongs on the way out, spend the effort on the exit instead of the ask. See Which PPO Should You Drop First? A Ranking Framework.
• Ask on a normal business cycle, not right after a rough quarter and not the week your contract auto-renews. A calm, routine tone is part of what makes the request land as reasonable rather than desperate.
• Ask one plan at a time. A letter that reads like it was mail-merged to five carriers reads like it was mail-merged to five carriers.

What to send#

One letter, three attachments.

1. Your cost increases. You do not need a study. You need your own numbers, stated plainly.
2. Your top-code comparison. Pull your ten highest-volume procedures for that plan and lay the plan's allowed fee next to your standard fee for each one. This is the same comparison that drives the eight-step math in How to Read Your PPO Write-Off Report; if you have already run that report for this plan, you are most of the way to a finished packet.
3. Your volume and tenure. How many patients, how many years in network, whether that volume has grown. A plan that has carried you for a decade with rising volume has more reason to keep you in good standing than to lose you over a modest increase.

Here is the cost side of the ledger, in the terms I actually use:

What has moved (my last five years)	Direction
Payroll	Up 10–20%
Supplies	Up 15–30%
Lab fees	Up, no single figure I would put a number on
Some carriers' fee schedules	Flat for 8–10 years

What has moved and what has not. Ryan's figures, from his own practices, not a published survey.

That last row is the whole argument. Everything else in the practice got more expensive. The fee schedule did not follow.

The ask: about 10%#

My rule of thumb is to ask for roughly a 10% increase across the schedule, or across your top codes if the plan will only consider line items.

Ten percent is deliberately not aggressive. It is a number a provider-relations reviewer can approve without kicking it up to a committee, and it is still real money once you multiply it across a full year of volume on a plan you see regularly. Asking for 40% invites a form-letter no. Asking for 10%, backed by your own numbers, invites an actual conversation.

A letter you can adapt#

This is a template, not a script. Change anything that does not sound like your practice.

Dear [Provider Relations / Network Manager name],

I am writing to request a fee schedule review for [Practice Name], provider ID [ID], under our participating agreement with [Plan Name].

Since our last fee adjustment, the cost of delivering care in our office has grown well beyond what our current schedule reflects: payroll, supplies and lab fees have all increased, and it has been [X] years since our fees were last reviewed. I have enclosed a comparison of our ten highest-volume procedure codes at your current allowed fees against our standard fee schedule, along with a summary of our patient volume and years of participation in your network.

We are requesting an increase of approximately 10% across our schedule, effective [date]. We value the [X] patients we see under this plan and would like to continue that relationship on updated terms.

Please let me know if you need additional documentation, and please respond by [date] so we can plan accordingly.

Sincerely, [Doctor name], DDS

Send it certified or at least trackable, keep a copy, and note the date. Whatever the answer, you want a paper trail: the same kind worth keeping for every plan you are in, alongside the actual contract and fee schedule you signed. More on building that binder in Leased PPO Networks and Credentialing: Know Which Plans You Are Actually In.

What a yes buys you#

A yes does not make a mediocre plan into a great one. It buys you time with a plan you are not ready to drop.

That time is worth something specific: it takes this plan off the top of your worst-payer list, which frees you to put your drop-rehearsal energy on the plans that said no, or the ones that never got asked because they were always going to be the first ones out. It also resets the clock. Put a date on your calendar to ask again in a year, with a fresh set of numbers, rather than assuming the new rate is fixed forever.

When the answer is no: three responses#

A no is not the end of the conversation. It is a decision point, and there are three reasonable ways to respond.

1. Table it and set a date to ask again. Document the request, the date, and the response in your contract file. Plans change reviewers, ownership and policy more often than dentists expect, and a request that gets a no this year can get a different answer in eighteen months, especially with a full year of fresh cost data behind it.

2. Check whether a leased or umbrella network reaches that same carrier at a better rate. Direct contracts with the major carriers are often 40–50% below full fee. Leased networks like Connection Dental, Careington or Zelis can carry a meaningfully higher schedule for the same carrier's plan, sometimes $1,000–$1,200 against an $800 direct-contract crown. It is not automatically a better deal: leased networks add layers between you and the carrier, and that complexity is exactly where underpayment hides. I cover how that works, and what to check before you sign, in Leased PPO Networks and Credentialing, and how to audit what you are actually being paid in Are Dental Insurance Companies Stealing From Your Practice?.

3. Move the plan into your drop-rehearsal math. Run the eight-step production pull, compare your discount percentage, and test the plan against the PPO drop calculator's break-even math: the calculator's rule is that your break-even patient loss equals your write-off percentage, assuming stayers pay full fee and giving no credit for the chair time you get back. If a plan says no to a reasonable ask and the drop math looks survivable, it may simply be time. See PPOs: Stay In or Drop Out? for the full framework, including which plan to drop first as a low-risk rehearsal.

Which of the three you pick depends on the plan. A carrier with heavy volume and steady growth is usually worth a table-and-retry. A carrier only reachable through a leased network is worth checking against that alternative. A carrier with thin volume, high write-offs and a flat no is usually a drop candidate.

Do this Monday#

• Pull the last twelve months of production for one plan you intend to keep, and your top ten codes for that plan.
• Compare the plan's allowed fee to your standard fee, code by code, and write down the average discount.
• Adapt the letter template above, attach both documents, and ask for about 10%.
• Send it trackable, keep a copy, and put the date in your contract file.
• If the answer is no, pick one of the three responses today (table it with a re-ask date, check the leased-network alternative, or run the drop math) rather than letting the plan default back to whatever it was doing before you asked.

None of this requires a lawyer or a negotiator. It requires the packet, the number, and a willingness to send something most dentists never send. If your practice tracks its numbers weekly, this kind of request should already be sitting in your profitability reporting as a recurring line item, not a once-a-decade event.