Should You Raise Your Fees Before Renegotiating With PPOs? Yes — raise your fees first, then renegotiate. On a fully contracted PPO book, a fee increase by itself usually doesn't change what you collect (the carrier still pays its contracted rate). But your fee schedule is the ceiling every negotiation is measured against. Set it too low and you're negotiating up toward a number you capped yourself. Raise it first, and you renegotiate from strength. On a fully capped book, a fee increase alone usually doesn't change what you collect. Your fee schedule is the ceiling every carrier negotiation is measured against. The honest sequence: raise fees first, then renegotiate from strength — in that order. If that sounds backwards, it's because most advice treats "raise fees" and "renegotiate" as two separate wins. They're not. They're one sequence — and the order matters more than either move alone. Why does raising fees alone often change nothing you collect? Here's the mechanic almost no one explains plainly. For a contracted PPO patient, the carrier pays the lesser of your submitted fee or their contracted allowable. If you're already at or above the allowable on a procedure, raising your fee doesn't move the payment one cent — the carrier still pays its rate, and the difference just becomes a bigger write-off on paper. So if your book is heavily contracted and your fees already sit above the carrier ceilings, a fee increase mostly inflates your "production" and your write-offs at the same time. Collections don't budge. Dentists who "raised fees" and saw nothing change weren't doing anything wrong — they were missing the second half of the sequence. The exception is real and worth naming: any fee-for-service, out-of-network, or non-covered volume — and your cash patients — collects at your actual fee. For that slice, a fee increase is real money immediately. So why raise fees first at all? Because your fee schedule is the reference point for the entire negotiation. Carriers benchmark, justify, and cap their offers against what you charge and what your market charges. If your listed fees are low, you've quietly told every carrier that a low number is acceptable — and you'll spend the negotiation climbing toward a ceiling you set yourself. Raise your fees to a defensible, market-aligned level first, and three things change: You stop leaving non-contracted money on the table — your FFS, out-of-network, and cash collections rise the day the new schedule goes live. You reset the ceiling. The contracted allowables you're negotiating against are now measured below your number, not at it — the gap becomes visible and arguable. You negotiate from evidence, not hope. "Here's where my fees sit in my market, and here's the gap on these specific codes" beats "I'd like more." You can't win a negotiation when only one side can see the number. What's the right order, step by step? See where your fees actually stand. Benchmark your fee schedule, code by code, against your local market. You're hunting for the codes where you sit well below where your area lands. Raise to a defensible level. Move underpriced codes up to a market-aligned position. This rarely costs you patients — most PPO patients pay a share of their plan's allowed amount, not your full listed fee, so a schedule increase is largely invisible to them. Rank your carriers. Look at what each carrier nets you after write-offs, not just gross production. Some are worth keeping, some watching, some worth a hard conversation. Renegotiate from strength. Go to the underperformers with your numbers — your raised, market-aligned fees, the specific codes, and the gap. You're arguing a documented gap from a defensible floor, not negotiating up to your own ceiling. Going straight to step 4 without 1–2 is the common mistake: you end up negotiating without knowing your own numbers. How big is the gap, really? 30–45% of full-fee production is lost to PPO write-offs (industry estimate) That's a large gap — but two honest caveats matter, because the hype around this topic is exactly why dentists tune it out: The gap is a ceiling, not a guarantee. It's the opportunity — the most you could recover — not money that lands automatically. Real recovery is phased, and how much you realize depends on your mix of contracted vs. FFS/non-covered volume. Raising fees on a fully capped book doesn't auto-collect. It's the enabler for the next move, not the move itself. Anyone telling you a fee increase alone "recovers 30%" is selling the headline, not the math. Done honestly, this sequence is still one of the highest-leverage things an owner-dentist can do — precisely because so few do it in the right order. Where Igion fits Igion was built around this exact sequence. UCR Market Fee Intelligence shows where your fees stand against your local market, code by code, with a phased increase plan — step 1. The Carrier Profitability Scorecard ranks your carriers and hands you a renegotiation toolkit built from your own numbers — step 4. The Practice Intelligence Bundle ("The Practice Playbook") puts them together in the right order — raise fees first, then renegotiate from strength — so you're not piecing the strategy together yourself. One PMS export, a plain-English plan, no subscription. See where your fees stand, or read how to renegotiate a dental insurance contract. Frequently asked questions Will raising my fees make me lose patients? Usually not. Patients with PPO coverage pay a share of their plan's allowed amount — not your full listed fee — so a listed-fee increase is largely invisible to them. The bigger risk runs the other way: leaving your fees frozen for years while your costs keep rising. If capped plans don't pay more, why raise fees at all? Two reasons: your FFS, out-of-network, and cash patients collect at your real fee immediately, and your raised schedule becomes the leverage for renegotiating the capped contracts from a defensible position. How do I know which of my fees are too low? Benchmark them against your local market by procedure code. You're looking for the codes where you sit well below where your area lands — not a guess, an actual market position. Should I drop a PPO instead of renegotiating? Sometimes — but only after you can see what each carrier actually nets you and what raising fees plus renegotiating would do first. Dropping a contract you could have fixed (or that's quietly profitable) is an expensive guess. Rank before you cut. What data should a fee benchmark be built on? Look for federal-grade, public-domain, carrier-bias-free benchmark data, modeled to your ZIP — so the number you're comparing against isn't set by the same carriers you're negotiating with.