How to Negotiate Insurance Fees Without Outsourcing
Profitability and sustainability are closely tied to how well practices manage insurance reimbursements. Many offices turn to third-party companies to renegotiate fees with insurance providers, but these services often come with a hefty price tag or commission structure.
The truth is, with preparation, confidence, and the right tools, dental office managers can negotiate these fees themselves — saving the practice money, gaining more control over their contracts, and proving their value as a key player in the office’s success.
Getting Started
Preparation is 90% of the battle. The more organized your data, the stronger your position will be. Success in negotiating insurance fees comes down to preparation.
Before reaching out to a payer, gather some key information. Make sure you have a copy of all of the fee schedules for the companies you are currently contracted with. I like to put everything in a spreadsheet so I can see how each fee schedule compares to the others. You really only need to look at the codes you use most often, so don’t worry about entering those codes you never use on your spreadsheet.
I also like to include our office fee schedule on that spreadsheet, so I can see what percentage of our fee we are actually collecting from insurance, and what we are writing off. This will help you know which fee schedules work for your office and which do not.
It will also be helpful to make a list of your top 20-30 codes. Some insurance companies may ask for this list to increase your most used codes instead of increasing the entire fee schedule.
Strategies for Negotiating Effectively
1. Make the First Contact
Once you have your fee schedules sorted and your spreadsheet ready, it’s time to start making the call. If you do not have contact information for your local representative for a specific company, you may have the option to speak with provider relations on the automated system, or you can speak with a benefits representative, and they can give you the correct information. You may have to do a little bit of research, but stick with it.
Always be professional and persistent. Approach negotiations with a business mindset and follow up with them if you don’t hear back from them within a week.
Also, never accept the first offer they give you; don’t be afraid to ask for a higher increase. The worst they can say is no, but what if they say yes to more? You won’t know unless you ask.
2. Focus on Key Procedures
You don’t have to push for increases across the board. If the increases being offered do not meet your expectations, ask if they will consider a larger increase on your top 30 codes. This is where your list comes in.
Targeting your most common or highest-cost procedures can have the greatest financial impact in some cases. You can also use the data in your spreadsheet to demonstrate how current reimbursements fall short compared to other fee schedules you are contracted with. Just be sure not to share protected information.
3. Know When to Push Back and When to Accept
Sometimes modest increases across many codes add up to more than a large increase on just one. Evaluate all increases closely. You need to decide if the increase being offered is sustainable for your practice. If it’s not, it may be time to cut ties with that insurance company.
Keep in mind that if you go out of network with an insurance company, they may pick you up through an umbrella company. In some cases, that can be a good thing, but in some cases it’s not ideal. If there are umbrella companies that you work with, you want to make sure you opt out of any insurance company you don’t want to work with through them.
However, if that umbrella company has a higher fee schedule, it may not be a bad idea to drop the direct contract and wait to be picked up through the umbrella company instead.
Pitfalls to Avoid
- Going in Unprepared- Without the data discussed early on in the article, your request is less likely to be taken seriously.
- Negotiating Too Infrequently- Fees should be reviewed and negotiated every 18-24 months.
- Overlooking Contract Terms- Pay attention to clauses on termination, reimbursement timelines, and participation requirements.
- Not Documenting Agreements- Always get confirmation of negotiated changes in writing. Verbal agreements can easily get lost, and written documentation ensures accountability.
- Accepting the First Offer- Negotiation is a process. Counter respectfully when the offer doesn’t align with your goals.
- Watch Your EOBs– Once the new fee schedule is in effect, pay close attention to your EOBs for the first few months, as some plans may not pay on the new fee schedule right away. You may have to contact them to get them to update the fee schedule in their system.
Take Control of Fee Negotiations
Fee negotiations don’t have to be outsourced. With preparation, persistence, and professionalism, you can successfully negotiate with insurance companies and directly impact your practice’s bottom line. The payoff is twofold: financial savings and a stronger, more confident leadership presence within the office.
Congratulations — you’ve just made yourself the MVP by saving thousands of dollars and boosting profitability for your practice.
About the Author
Nikki Ray, FAADOM
Nikki is the Office Manager at Cornerstone Family Dentistry. She has 14 years of experience in the dental field, all at the same office.
She earned her FAADOM designation in 2025 and is on track to achieve her MAADOM designation in 2026.
Nikki is passionate about creating a positive, patient-centered experience while helping her team deliver exceptional care every day. Outside the office, Nikki enjoys spending time with her husband and two daughters.
