Earlier this year, two California dentists shared why and how they went out of network with one or more dental benefit plans, as part of CDA’s “Member to Member” article series.
Felicia L. Lai, DDS, took a different approach when dental plans’ inadequate reimbursement rates threatened the financial stability of the Bakersfield practice she has owned for nearly 30 years. Instead of going out of network with the plans, she successfully renegotiated rates using patience, persistence, organized data and support from CDA analysts.
She explains how in this Q-and-A.
How often do you re-evaluate your contractual participation with dental plans?
Our review frequency depends on the terms of each individual plan. Some plans allow more frequent reconsideration, while others require a waiting period before renegotiation. The time period typically ranges 12-24 months.
When did you last attempt to renegotiate your reimbursement rates with dental plans? Were you successful?
Our most recent negotiation began in November 2025 and concluded in February 2026. Before that, we negotiated December 2023 through May 2024. These experiences reinforced that negotiations require patience, persistence and multiple conversations rather than a single discussion. The process took several months, but because of our continued follow-up, we reached an outcome that better aligned with the needs of our practice.
Ultimately, we negotiated successfully with four out of five plans. One plan did not allow for provider-initiated updates or negotiations. We later learned that our office had been grandfathered into a commercial direct contract that was no longer being offered. Leaving that contract and attempting to rejoin the network would have required us to participate through a leased network instead.
Did you negotiate the entire fee schedule or focus strictly on your top 20-30 most frequently billed CDT codes?
We focused on the top 20–30 CDT codes rather than attempting to negotiate the entire fee schedule. The top 10 codes for our practice were primarily preventive and diagnostic services, followed by commonly performed restorative procedures such as composite fillings and crowns.
We also included higher-production procedures like implant-supported restorations along with a few less frequently used codes, like removable dentures, toward the end of the list. Targeting a defined group of codes made the request more focused and manageable. Narrowing the list allowed us to prioritize the fees that impact our practice the most. It also gave us a clear, organized set of fees to present during negotiations.
Did you handle the negotiations yourself, or did you hire a specific dental negotiating firm to help?
Our office team handled the negotiations, primarily myself and two team members, Erika Solis and Elyse Wong, my patient benefits and treatment coordinators. I relied on both of them greatly.
We followed a dual approach: 1) Present our case from an analytical perspective with actual patient data displayed in tables. 2) Use email and telephone communication for the actual negotiation.
We learned lessons through trial and error. Handling the negotiations ourselves required a significant amount of time, persistence and follow-up, but it allowed us to become even more familiar with our own fee schedules, write-off percentages and the financial impact each plan had on our practice. With the right resources and preparation, we saved the practice the additional expense of hiring an outside negotiating firm.
Did you highlight qualities of your practice or leverage any other factors during negotiations?
We emphasized the quality and sustainability of our private practice, our conservative and patient‑centered approach, and our commitment to remaining an in‑network provider. We also highlighted the significant chair time, staffing, laboratory fees, supplies and overhead required to provide the procedures under review.
Our data-driven analysis was another major leverage point. We presented actual patient claims, reimbursement amounts, write-offs, required procedure time, and treatment details in clearly organized tables that made the magnitude of the reimbursement gap immediately apparent. Some of our examples revealed an average write-off of approximately 42%, with some adjustments exceeding the actual insurance payment received. The data was logically formatted in tables that illustrated a consistent pattern of inadequate reimbursement.
We also showed that this was not an isolated issue with one procedure but was instead a broader reimbursement problem affecting services across the practice, from preventive care and diagnostics to restorative treatment. We specifically highlighted the amount of chair time required for these procedures. Several of the examples involved 75 to 120 minutes of patient care, which put the reimbursement amounts into perspective regarding time, supplies and resources required to provide the treatment.
For procedures involving crowns and other restorative work, we identified laboratory fees, preparation time and multiple appointments as additional considerations.
When plans responded to your request with ‘no’ or said they were paying at the highest fee schedule for your region, how did you proceed?
We did not treat an initial “no” as the end of the negotiation. When told we were already on the highest regional fee schedule, we acknowledged the information but continued advocating for adjustments.
We selected three to five priority codes from our original list and asked the plan to reconsider those specific fees, emphasizing the strengths of our private practice, including our conservative treatment philosophy and lack of grievances.
We also used geographic fee comparison tools to verify regional benchmarks. We made it clear that while we valued our partnership with each plan and wanted to continue participating, rising operating costs required us to evaluate whether remaining in‑network was financially sustainable.
Without presenting an ultimatum, we alluded to the possibility that we eventually might need to consider going out of network if reimbursement rates no longer made financial sense. From there, we requested specific fee amounts for priority codes rather than asking whether “anything else” was available.
If the plan agreed to increase even one code, we reviewed the entire revised fee schedule to ensure no other fees were lowered to offset the increase. Once we secured one adjustment, we continued advocating for additional increases. The process went inch‑by‑inch, but persistence ultimately resulted in improvements across several top‑producing codes, including crowns, prophys, and radiographs.
Did you use CDA resources? If so, which ones?
Miguel Mariona, CDA associate analyst for dental benefits and practice management, was most helpful with educating us about the process and providing resources including FAIR Health Consumer and its Fee Estimator for Healthcare Professionals. With these tools, we could compare our fees and reimbursement levels with other providers in our ZIP code and research specific dental procedure codes.
If a colleague was considering negotiating with dental plans, what advice would you give them?
I have several recommendations, so I’ll put these into a numbered format for easier reference.
- Be persistent and proactive when trying to reach the correct network development or provider relations representative. Responses can take several weeks, so document each contact attempt and request written confirmation that your emails, letters and phone calls are received. Verify that you are communicating with the representative responsible for your geographic region and follow up consistently through both email and phone.
- Be prepared with organized data and a clear explanation of why a fee adjustment is warranted. Know which procedures matter most to your practice and have supporting data readily available, including current reimbursement, write‑offs, required procedure time, laboratory costs, and other expenses. Instead of making a general request for higher reimbursement on all procedures, identify specific procedure codes/fees you want reconsidered and explain why they are not sustainable.
- If the plan provides information that does not align with your records, we recommend approaching the discrepancy professionally and asking for clarification before proceeding.
- Use actual numbers to demonstrate financial impact. For example, if your office fee is $1,200 and the plan allows $900, you are writing off $300 or 25% every time you complete the procedure. Reviewing these differences across your most frequently billed procedures can clearly illustrate the financial strain. If you are told “no” from a plan, continue the conversation. Highlight the codes with the largest gaps and request specific increases. Even if the plan will not adjust every code, progress may still be possible on individual fees. When increases are offered, review the entire fee schedule to ensure no other fees were lowered to offset them.
- To avoid the risk of fee stacking, determine whether your contract is directly with the particular plan or an affiliate under an umbrella PPO/leased network. Leased network arrangements can be complicated, so examine your contract options carefully before making any decisions to join or go out of network. Look at your own patient base and determine how many patients are actually participating in those plans to evaluate whether remaining in network makes financial sense for your practice. Depending on the situation, you may be able to negotiate directly with the umbrella plan or explore direct contracts with the individual plans participating under that network.
- Last but not least, use CDA resources and other tools to support your request and to stay current on trends in the dental benefits industry. Being well‑prepared, persistent and specific makes it easier to present a strong case in negotiations and achieve meaningful improvements for the practice.
More ahead in CDA’s interview series with member-dentists
Read more articles in CDA’s series about member-dentists who have pursued diverse practice models, approaches to working with dental plans and patient care financing options.
Related resources:
- Evaluating Dental Benefit Plans Checklist ‒ CDA
- Fair Health – an independent nonprofit that provides information about healthcare costs