By Megan Wyrick, Orthodontic Financial Consultant & Co-Founder, The Wyrick Outlook
A dental insurance fee negotiation letter is a written request asking a carrier to raise the contracted reimbursement rates on your PPO agreement. It is one of the most overlooked levers an orthodontic practice has over its own revenue, and most offices never send one. They assume the fee schedule they signed years ago is fixed. It is not.
A quick, honest note before we start: we are orthodontic only. This article says “dental” because that is the word practices actually type into Google, but every step below is written for orthodontic contracts, orthodontic codes, and the way ortho gets paid. Not general dentistry.
Here is the part nobody says out loud. Insurance companies will not raise your rates on their own. Ever. That allowance on your comprehensive treatment code has probably sat flat while your lab bill, your staffing, and your supply costs all climbed. The carrier is fine with that. The only way the number moves is if you ask, in writing, with your numbers in front of you.
And this matters more in ortho than almost anywhere else in the practice, because of one thing we come back to constantly: production means nothing without collections. A higher contracted rate is not a one-time win. It raises what you collect on every single start that runs through that plan, for the full length of treatment. Get it right once and it compounds quietly in the background for years.
What is a dental insurance fee negotiation letter?
A dental insurance fee negotiation letter is a formal, written request sent to a carrier’s provider relations or contracting department asking them to increase the contracted allowances on your orthodontic fee schedule.
It is not a complaint and it is not a threat to drop the plan. It is a business case. The strongest ones are short, specific, and backed by your own data. A letter that lands well usually includes:
- The exact orthodontic codes you want repriced (D8080, D8090, D8670)
- Your current contracted allowance next to the increase you are requesting
- A copy of your full office fee schedule
- A plain reason the current rate no longer works
- A response deadline, usually around 30 days
That is the whole document. What decides whether it works is not the wording. It is the homework you do before you write a single line, and knowing what bargaining position you are actually in.
Why orthodontic contracts get stuck (and general dental advice misses this)
Most advice about negotiating fees with dental insurance companies assumes a general practice with two hundred active CDT codes. An orthodontic contract is a different animal, and that assumption quietly misleads you.
A general dentist negotiates across a broad code set: exams, cleanings, fillings, crowns, extractions, everything. Ortho does not work that way. Your revenue lives in a tiny cluster of codes, mostly comprehensive treatment (D8080 for adolescents, D8090 for adults) plus the periodic visit code (D8670). That concentration is a problem and an opening at the same time.
The problem: because ortho bills over the full course of care, a low allowance does not sting once. It bleeds slowly across eighteen to thirty months of a case, and it does that on every patient on that plan. A rate that looks “only a little low” is doing real damage by the time you notice.
The opening: you do not have to argue about two hundred fees. You have to make a clean case on a handful. That is a far easier letter to write and a far easier request for a carrier to say yes to, because you are asking them to move three numbers, not rebuild a schedule.
This is where we disagree with a lot of the “just drop every PPO” content floating around. Dropping a plan is sometimes right. But walking away from a contract you never even tried to reprice is leaving money on the table out of frustration, not strategy. Ask first. You can always leave later.
Practices feel this tension in their own words. One office told us flat out they were still asking, “Is it even worth being ‘in-network’ at all.” Another described exactly the gap this letter fills: they wanted help with “How to set a fee schedule and payment plan. How to best present fees and contracts. Best insurance strategies (in-Network vs OON, whether to take assignment of benefits).” Those are real questions from real ortho teams, and the answer almost always starts with knowing your own numbers cold.
Not sure which contracts are worth renegotiating?
twoCOACH sits down with you and your real numbers, your fee schedule, your net collections, your AR, and helps you decide where a higher rate actually moves the needle. Coaching from people who have sat in your chair, not a binder from a stranger.
Book a twoCOACH strategy callBefore you write anything, pull your numbers
The letter is the last five percent of the work. The first ninety-five percent is knowing, with numbers, why your current rate is a problem.
Before you draft, pull three things from your practice management software and your recent EOBs: your standard office fee for each core ortho code, the current contracted allowance from that carrier for the same codes, and the gap between them expressed as what you write off per case. Do this for your highest-volume plans first. If you are writing off a large share of your production to one specific carrier, that carrier is your first letter, and the write-off figure is the heart of your argument. Owner-level coaching on your practice numbers helps you read those write-offs correctly, and so does real command of your billing data, the same muscle we build in our orthodontic insurance billing course.
In-network vs out-of-network: what bargaining position you actually have
How much room you have depends entirely on whether you are in network. The letter is the same shape either way, but what you can reasonably ask for is not.
| What you are dealing with | In network (participating PPO) | Out of network (non-participating) |
|---|---|---|
| Who sets the fee | The carrier’s contracted schedule | Your own office fee |
| What the letter asks for | A raise to specific contracted codes | Usually not a fee request; this is a coverage or assignment conversation |
| Your bargaining position | Your patient volume and clean claim history | You already control your fee; the question is patient out-of-pocket |
| Realistic near-term outcome | A partial or phased increase on core codes | Little to negotiate on the rate itself |
| The real risk of asking | Very low; a “no” changes nothing | Not applicable |
One caveat from the field: carriers vary widely. Some review requests on a set cycle, some almost never, and a few will only revisit when your contract renews. Ask provider relations how their process works before you assume a “no” is permanent.
If you are in network, the request is real and the downside is small. The worst answer is no, and no leaves you exactly where you already are. If you are out of network, your fee is already yours; the more useful work there is on coverage, assignment of benefits, and how you present cost to families, not on a rate letter.
The fee negotiation letter template
Here is a template you can reword and send. Keep it to one page. Fill every bracket with a real number from your own data, and enclose your fee schedule.
[Practice letterhead]
[Date]
[Carrier Name]
Attn: Provider Relations / Contracting Department
[Address, fax, or provider portal reference]
Re: Request for orthodontic fee schedule review
[Practice Name] | Provider ID / TIN: [number]
To the Provider Relations team,
[Practice Name] has been a participating orthodontic provider with
[Carrier] since [year]. We value the patients your plans send our way
and intend to keep serving them in network.
We are writing to request a review and increase of our contracted
orthodontic fee schedule, which has not been adjusted since [year of
last review]. Over that period our lab, staffing, and supply costs have
risen materially, while the contracted allowance on our core
orthodontic codes has stayed flat.
We are specifically requesting an increase to the following codes:
- D8080 (comprehensive ortho treatment, adolescent):
current allowance [$X], requested [$Y]
- D8090 (comprehensive ortho treatment, adult):
current allowance [$X], requested [$Y]
- D8670 (periodic orthodontic treatment visit):
current allowance [$X], requested [$Y]
Our full office fee schedule is enclosed for your reference.
[One or two sentences of practice-specific justification: for example,
a low claim-denial rate, strong case completion, limited local access
to participating orthodontists, or years of clean participation.]
We would appreciate a written response by [date, roughly 30 days out].
If a full adjustment is not possible this cycle, we are open to a phased
increase over the next 12 to 24 months.
Thank you for your time and for the partnership.
Sincerely,
[Owner / Doctor Name], [Practice Name]
[Phone] | [Email]
A few notes on why it is built this way. You name the codes because a request the carrier can act on beats a vague ask about “fairness.” You enclose the schedule because it removes a reason to stall. You give a deadline because open-ended requests sit in a queue forever. And you offer a phased option because a partial yes is still a raise, and it keeps the door open for the next cycle.
When I started as a financial coordinator, the practice I worked for had never heard of rate increases. When I finally logged into the insurance portal, it showed the office had not had a rate increase since 2008, the year the doctor took ownership of the practice. That was concerning, because it was years of lost revenue, gone simply because no one had ever asked for an adjustment. I spent the next few months calculating, submitting, and getting rate updates approved across their carriers. The case was not hard to make: no increase since 2008, and office fees that had climbed a lot since then, so an adjustment was clearly warranted.
After you send it: what actually happens next
Do not expect a fast yes. Carriers move on their own clock, and a fee review commonly takes a couple of months to work through, sometimes longer. Log the date you sent it, calendar your follow-up for the deadline you set, and if you hear nothing, call provider relations and reference your letter by date. Persistence is most of the job here.
Once you send a request, watch what comes back, because both answers teach you something. The times I have gotten a yes, it was usually because the fees had not been touched in years, or because I could show the carrier exactly how much the practice was writing off and why staying in network did not make sense without an increase. The times I got a no, that was the signal to sit down and honestly analyze whether being in network still benefited the practice at all.
When a raise comes through, the work is not over. A better contracted rate only shows up in the bank if your team actually posts it, catches short-pays, and follows up on what the plan still owes you. That is the difference between what you produce and what your practice truly collects, and it is why we treat higher rates as one piece of a larger revenue system, not a finish line. It is also the exact skillset we build in our financial coordinator training, so the raise you win does not quietly leak back out.
If you want to go deeper on the whole revenue picture, our take on dental practice growth strategies puts fee strategy where it belongs: alongside clean insurance verification, tight collections, and systems that do not fall apart when one person leaves.
A higher rate only matters if you collect on it.
If you want a second set of eyes on your fee schedule and the systems behind what your practice actually collects, twoCOACH is one-on-one coaching with B and Megan on the numbers that run your office. No stiff binder, no stranger flying in.
Start with twoCOACHFrequently Asked Questions
Can you actually negotiate dental insurance reimbursement rates?
Yes. Contracted PPO fee schedules are negotiable, and most orthodontic practices simply never ask. Carriers will not raise your rate on their own, so a written request to provider relations is the trigger. A “no” leaves you exactly where you started, which is why the downside of asking is close to zero.
How often should an orthodontic practice request a fee increase?
Every 12 to 24 months, or any time your operating costs jump. Insurers do not adjust for inflation on your behalf, so treat the fee review as a recurring calendar task, not a one-time event.
What should a dental insurance fee negotiation letter include?
A strong dental insurance fee negotiation letter is one page and includes a handful of specific things. Open by confirming you are a participating provider and want to stay in network. State that you are requesting a review of your contracted orthodontic fee schedule and note how long it has been since the last adjustment. List the exact codes you want repriced, almost always D8080, D8090, and D8670 for ortho, with your current allowance next to the amount you are requesting. Enclose your full office fee schedule so the carrier has the data in hand. Add one or two lines of practice-specific justification, such as a low claim-denial rate or limited local access to participating orthodontists. Close with a response deadline of about 30 days and an offer to accept a phased increase if a full one is not possible this cycle. Specific and short beats long and emotional every time.
Will the insurance company drop us if we ask for higher fees?
Almost never. A rate request is a routine provider relations conversation, not a breach of your agreement. The realistic outcomes are a yes, a partial or phased yes, or a no. None of those ends your participation. If a carrier is genuinely hostile to a reasonable, data-backed ask, that itself is useful information about the relationship.
Should we negotiate fees or just drop the PPO?
Try to reprice before you walk. Dropping a plan can be the right call once you know your numbers, your patient mix, and how much of your schedule that carrier fills, but it is a bigger decision with real effects on new patient flow. Sending the letter first costs you almost nothing and sometimes fixes the problem outright. If the rate still does not work after a genuine attempt, then a network decision is an informed one rather than a frustrated one. This is exactly the kind of call worth talking through with a coach who has run the math on practices like yours.
About the Author
Megan Wyrick is Co-Founder of The Wyrick Outlook, where she helps orthodontic practices run clean, repeatable revenue cycles instead of reactive billing and collections. With more than 15 years inside orthodontic offices across scheduling, financials, marketing, and treatment coordination, she has worked in nearly every seat in the practice. Megan and her sister B have partnered with 450+ orthodontic practices. Learn more about Megan and The Wyrick Outlook team here.