How to Approach Dental Insurance Negotiations Like a Pro

Dental insurance participation can be one of the most frustrating—and financially impactful—aspects of running a practice. With increasing complexity around PPO contracts, shared networks, and post-COVID industry shifts, providers need to be more strategic than ever.

Here’s what dental offices should know before diving into fee negotiations or reconsidering insurance network participation.

1. Stick to Honest, Data-Driven Negotiation

Successful negotiations start with clean data and compliance:

• Don’t inflate your cash fees just to gain leverage. Insurance companies compare submitted claims against your usual fees and may reject changes if they see inconsistencies.

• Make sure your fee schedule is up to date in your software before you start negotiating. Carriers rely on that data to validate your proposal.

• Avoid sharing fee schedules with other practices. It’s not only a contract violation in most cases—it can put your license and credibility at risk.

• Focus on your top-producing codes. Most general dentists generate 90% of their production from around 30 codes. Prioritize those when preparing to negotiate.

Being accurate and intentional with your numbers can lead to stronger, longer-lasting results.

2. Understand the Web of Shared Network Agreements

Shared networks are quietly reshaping the way providers get paid—and not always for the better.

• Agreements can be added at any time, without your explicit approval or written notice.

• Most major insurers (except Delta) now use these third-party access points, meaning your negotiated rates may be extended to other networks without clear consent.

• Leaving a PPO contract doesn’t mean you’re fully out. You may need to opt out of 5–6 individual networks to fully disengage—and each opt-out can take 30–60 days to process.

Knowing who you’re really contracted with—and where your rates are being used—is critical. If you’re not tracking this already, it’s worth prioritizing.

3. What to Know About Delta Dental

Delta Dental plays by its own rules, and understanding those rules can help you decide how—or if—you want to participate.

• They rarely negotiate PPO fees unless you’re in an under-served area.

• Participation is tied to individual dentists, not your practice’s tax ID.

• In some states, you can still maintain Premier-only status—but only if your contract allows it.

• New practices are increasingly opting out of Delta PPO due to low reimbursement rates and tight restrictions.

If your current Delta contract isn’t pulling its weight, it may be time to re-evaluate.

Final Thoughts

PPO participation isn’t all-or-nothing—but it does require a thoughtful strategy. Understanding shared agreements, contract specifics, and your own internal billing systems puts your practice in a stronger position—whether you’re renegotiating or opting out. Whatever model you choose, your billing systems need to support it—clean claims, efficient verification, and strong follow-up processes are key to success.

If you’re not sure where to begin, start by auditing your current fee schedules, top procedure codes, and payer mix. The right information is the first step toward stronger negotiations—and better outcomes for your bottom line.